[Is lumbosacral MRI in complemetary health insured patients, requested based on scientific guidelines?]

The request for lumbosacral MRI in Iran based on previous studies is high [almost half of all MRI cases], so, our study is concerned with investigating the necessity of lumbosacral MRI request in patients with low back pain that is covered by complementary health insurance in Tehran through comparing MRI practice with valid guidelines. Information of 274 complementary insured patients at Dana Insurance Company in Tehran, who had undergone low back MRI was studied. A portion of information in the questionnaire including age, sex, the physician's field of specialty, and MRI report, was derived from the medical records. Other information based on guidelines indications, including duration of the prolonged back pain, record of associated infection, malignancy or trauma, saddle anesthesia, lower limb motor deficit and incontinence of urine or feces, was elicited from patients orally. Males represented 35% and females 65% of patients. Also, males were on average 10 years younger than females. Over 90% of MRI scans were requested by three fields of specialty [orthopedic, neurosurgery and neurology]. Considering the indications of lumbar spine MRI request [prolonged back pain of more than one month duration, incontinence of urine or feces, lower limb motor deficit, saddle anesthesia, recent related trauma, infection and malignancy], approximately 20% of lumbar spine MRI scans were prescribed in accordance with guidelines. Out of every five cases of lumbar spine MRI, four cases were not requested based on guidelines, suggesting needs for local guideline design and revising the manner in which MRI scans are prescribed for low back pain in complementary health insured patients in Tehran.

first study of patient safety culture in Iranian primary health centers

Although the error in health care has received attention recently, patient safety culture in health centers has been relatively neglected. To measure the patient safety culture in primary health centers. A cross-sectional study, utilizing the modified version of the Hospital Survey on Patient Safety Culture [HSOPSC] developed by the Agency for Healthcare Research and Quality [AHRQ] and a demographic questionnaire. Healthcare staffs from health centers were participated in the survey. The patient safety culture score including subscores on 11 dimensions and 39 items; patient safety grade and number of events reported. The overall positive response rate of patient safety culture was 57 +/- 16.8 [CI [95]55%-59%]. The dimensions that received higher positive response rate were "Teamwork across units of health center", "Teamwork within units", "Head of center support for patient safety". The lowest percentage of positive responses was "Non punitive response to error". There were no relationship between working years and patients safely culture score. Similarly, no relationship was found between professional, gender and total patients safely culture score. Statistical analysis showed discrepancies between Iranian health centers and the US hospitals in three dimensions. For improving patient safety culture in health centers, it is necessary to have enough staff and establish an environment to be open and fair with staff which helps report errors spontaneously and without any fear. The findings of this study could be used to measure changes in patient safety culture over the time.

BMI correlation with psychiatric problems among 10-18 years Iranian students

Obesity and its related emotional and physical consequences are a worldwide problem. Obese individuals are usually stigmatized. This study is proposed to assess the correlation between body mass index, gender and age with psychiatric symptoms among Iranian students. A number of 9172 students aged 10-18 years [53.5% girls and 46.5% boys] from all provinces of Iran participated in this study. Data was collected using the global school based health survey questionnaire of the World Health Organization [GSHS-WHO]. Overall, prevalence of predictors of having emotional problems, depression and anxiety were 27.8%, 29.7% and 11.5% respectively. Girls had significantly higher prevalence of predictors of psychiatric symptoms. Overall obesity was a protective factor against emotional problems OR [CI95%]:0.79[0.65-0.98], but it was attributable to obese boys OR [CI95%]:0.72[0.55-0.95]. Depression and anxiety symptoms were higher in intermediate school girls and high school girls and boys. More attention should be paid to girls' psychological problems. Besides, obesity had an indirect relation with predictors of having psychiatric problems in Iranian boys and it might be due to: [1] parents' beliefs about heaviness as a predictor of healthiness, [2] boys' lower vulnerability to psychological consequences of obesity and [3] lower pressure from parents on their obese sons to lose weight

Comparison of serum uric acid, iron and total iron binding capacity [TIBC] levels in pre-eclamptic and normal pregnant women

The objective of our study was to compare uric acid, iron and TIBC levels in normal and preeclamptic pregnant women and determine their relations with maternal and fetal complications. A case control study was conducted in 200 normal and preeclamptic pregnant women. At 32-40 weeks of pregnancy [third trimester] a blood test was taken in order to measure the uric acid, iron and TIBC and their relation with maternal and fetal complications. Uric acid level showed significant difference [4.58 +/- 0.73, 4.87 +/- 0.58, p=0.002] between two groups of pre-eclamptic and normal women. The iron and TIBC level had no significant difference in either group. The uric acid level and iron had significant differences between two groups with and without maternal complication, respectively [4.69 +/- 0.66, 5.05 +/- 0.59, p<0.05] [387.42 +/- 82, 405.24 +/- 57, p<0.05]. There was not any difference in three parameters between groups with and without fetal complication. The BMI was significantly higher in preeclamptic group and has positive relation with uric acid level. If we consider 29 as BMI cut-off point; it will be associated with 73% sensitivity and 67% specificity in preeclampsia determination. Using 4.55 as uric acid cut-off point, the sensitivity is 76% and specificity is 49%.Although the higher level of uric acid, higher BMI scale and positive roll-over test are associated with preeclampsia, but they are not very strong predictors as single test

One-month survival after coronary artery bypass graft [CABG]

To determine One-month survival after CABG in Shariati Hospital. We followed 340 patients who underwent Isolated-CABG in Shariati Hospital and used survival analysis to compare common coronary risk factors and to assess surgical factors related to survival after CABG. Smoking was more prevalent in males than in females but prevalence of hypertension, diabetes and hperlipidemia was greater in women. Female subjects were older, had greater Body Mass Index [BMI] and left ventricular ejection fraction [LVEF] and had undergone more non-elective surgery compared to males. Most patients had received 3 or 4 grafts [range 1-6 grafts]. There was no difference in aortic cross clamp and anesthesia time between the two genders. Females were hospitalized for longer periods after surgery and their mortality rates were greater. One-month survival ratio estimated by the Kaplan Meier method was 97.1% and 88.4% in males and females respectively. The overall survival rate was 95.3%. The factors related to poor survival were: female gender, non-elective surgery, lengthy aortic cross clamp and anesthesia time and the history of: hypertension, hyperlipidemia, previous CABG and CCU hospitalization

Desmoglein ELISA in the diagnosis of pemphigus and its correlation with the severity of pemphigus vulgaris

Anti-desmoglein 3 and 1 autoantibodies are involved in the pathogenesis of pemphigus diseases. Our objective was to assess the value of ELISA in the diagnosis of pemphigus and its correlation with the severity of pemphigus vulgaris. Based on clinical presentation and histopathologic confirmation for the diagnosis of the pemphigus, 38 patients took part in the study. Sera of the patients were tested by desmoglein 1 and desmoglein 3 ELISA. Also, direct immunofluorescence was performed for all patients which revealed positive results in 36 patients [94.7%]. ELISA was positive in 37 of 38 pemphigus patients [Sensitivity: 97.3%]. The relationship between desmoglein 1 index values and skin severity was statistically significant [p<0.05]. Desmoglein 3 index values increased with oral severity although this was not statistically significant. Iranian patients similar to Indian patients had higher positive anti-desmoglein 1 autoantibodies. Desmoglein-ELISA test is appropriate in the diagnosis of pemphigus. Desmoglein 1 index value is statistically correlated with the severity of pemphigus vulgaris

survey of pediatricians' knowledge on asthma management in children

Asthma is one of the most common acute and chronic conditions in children, and the pediatricians are expected to provide an important role for asthma care in this age group, however there is no published information describing the different aspects of their practices about children asthma in Iran. This study was done to characterize the knowledge of the Iranian pediatricians about the diagnosis, treatment and education of asthma in children. Validated questionnaires were completed by 193 pediatricians from different parts of Iran during the International Congress of Pediatrics in Tehran. A total of 193 returned questionnaires [96.5%] were eligible for the survey and analysis. About 49% of the respondents were male and 18% were sub-specialists. Wheezing was the most common mentioned symptoms in taking asthma into consideration. About 40% of these physicians had no plan for doing spirometry in eligible children and 35.2% of them did not have familiarity with peak flowmeter. Also about 17.6% of them paid no regular visits to their asthmatic patients. Only 29% of the respondents indicated that they would prescribe inhaled corticosteroids for a 6-year-old child with moderate persistent asthma and 73.3% of them would prescribe inhaled bronchodilator [Salbutamol] for an acute asthmatic attack as the first drug, while 17.1% of them used epinephrine injection for this purpose. About 42.2% of the respondents did not consider any education or action plan for their patients and only 60.6% of them had access to standard guidelines and educational programs. The results show that there are numerous aspects of children asthma management in Iran which are not consistent with standardized guidelines and recommendations. This survey and the attained information suggest areas for interventions to improve the pediatricians' knowledge about asthma and the disease management