phase II study of docetaxel, cisplatin and 5- fluorouracil [TPF] in patients with locally advanced head and neck carcinomas

The combination of cisplatin and 5-fluorouracil [PF] is currently considered a standard and effective regimen for the treatment of advanced head and neck carcinomas. The aim of this study was to evaluate the efficacy and safety of docetaxel, cisplatin and 5-fluorouracil [TPF] in patients with unresectable head and neck carcinomas. Forty-six patients with previously untreated non-metastatic stage IV head and neck carcinomas were enrolled. All patients received three cycle of induction chemotherapy with docetaxel [75mg/m[2]], cisplatin [40 mg/m[2]] [days 1-2/, and 5-FU [500 mg/m[2], days 1-3], repeated every 21 days. Following induction chemotherapy, all patients underwent concurrent chemoradiotherapy using weekly cisplatin [30 mg/m[2]] and a median total dose of 70 Gy was delivered. Clinical response rate and toxicity were the primary and secondary end-points of the study. There were 31 men and 15 women. All patients had non-metastatic stage IV [T2-3N2-3 or T4N0-3] of disease. Overall and complete response rates were 74% and 24% respectively. Advanced T4 classification was associated with poorer response rate [p value= 0.042]. The major [grade 3-4] treatment-related toxicities were myelosuppression [78%], anorexia [13%], diarrhea [7%], emesis [11%] and stomatitis/pharyngitis [24%]. In comparison with the data of historical published trials of the PF regimen, the TPF regimen was more effective. However, the TPF regimen appears to be associated with a higher incidence of major toxicities. Therefore, our limited findings support the TPF regimen as an alternative chemotherapeutic regimen for advanced head and neck carcinomas

World AIDS day campaign in Iran: a population-based study

This was a population-based study to examine whether the campaign for World AIDS Day 2005 in Iran was successful. A random sample of the general population was asked whether they had seen the campaign and knew the message. They were also asked whether it was attractive; there was anything offensive, whether the campaign could raise awareness, and how they rated the campaign. In all 1215 individuals were approached and 1014 agreed to take part in the study. Only 43% [n= 435] said that they had seen the campaign. Of those who had seen the campaign 79% knew the subject and 24% acknowledged the main message correctly. Only 27% said it was very attention getting or eye-catching, 64% said the campaign could raise awareness but 75% said the message was unclear, and confusing. A few respondents [23%] rated that the campaign overall looked good or very good. The findings suggest that if the World AIDS Day is an opportunity to give visibility to the problem, then there is an urgent need to think seriously to choose other approaches for raising global awareness on the state of the epidemic in Iran and elsewhere

[Self poisoning with suicidal intent- Part I]

Self poisoning is one of the most common forms of suicide- especially in adolescents- and constitutes a major reason for hospitalization and referral to emergency wards. The high frequency of repeated attempts together with the shortage of reliable epidemiologic data makes it difficult to plan effective preventive measures. The present article is the first section of a two-part paper on the epidemiology of self-poisoning in Iran. This was a cross-sectional study conducted in Tehran, Mashad, Tabriz, Isfahan, Shiraz and Kermanshah [5 major provinces of Iran]. Data were collected using a structured questionnaire and were analyzed in a descriptive fashion. In all, 723 cases were studied. There were 550 cases [%71] of self poisoning with suicidal intent. The mean age of those who had attempted suicide was [25.42 +/- 10.26] years; sixty percent [n=330] were female and the remaining 40% [n=220] were male. Eighty percent of attempted suicides involved the use of drugs; other suicide modalities included poisons, psychotropic substances and other chemicals. Thirty-one percent of the cases reported previous suicidal gestures. The mean number of past suicidal attempts was 2.08 [SD = 2.28]. The findings show that the frequency of attempted suicide is relatively high. To deal with the current situation, issues of mental heath have to be addressed more attentively and hospital emergency wards must be provided with adequate equipment and trained manpower [psychologists, psychiatrists, toxicologists, etc]

[Self poisoning with suicidal intent- Part II]

Self poisoning is one of the most common forms of suicides and a frequent cause of hospitalization in Accidents and Emergency Departments, especially in the younger age groups. This research was prompted by the current lack of reliable and adequate information on the epidemiology of suicide, and its main objective was to provide a basis for effective interventions in the future. The present article is the second section of a two-part paper on the epidemiology of self-poisoning in Iran. This was a cross-sectional study conducted in Tehran, Mashad, Tabriz, Isfahan, Shiraz and Kermanshah [5 major Provinces of Iran]. This article deals with results from data analysis and comparisons between cases of suicide and accidental self-poisoning. In all, 723 cases were studied. Among those who had committed suicide, the frequency of severe physical illness was greater in women compared to men [P<0.002]. The mean age of the subjects who expressed regret after the suicidal gesture was significantly lower than those who did not [P<0.003]. Moreover, subjects who had a real intention to kill themselves were significantly older than those who did not have such an intention [P<0.01]. Results from logistic regression analysis showed that higher age, male gender, and residing in Tehran were associated with a higher probability of deliberate self-poisoning [P<0.001 for all the three variables]. In addition, having a definite plan for suicide and previous history of a suicidal attempt were significantly related to having real intention to die [Odds ratios 2.52 and 1.87, respectively]. Most hospitalizations in poisoning wards [>74%] involve suicidal self-poisoning. Measures must be taken at all three levels of prevention with special attention to the epidemiology of the problem in different regions

[Patient satisfaction with emergency departments]

Patient satisfaction is an important indicator of quality of care and service delivery. The objective of this study was to examine patients' satisfaction with the emergency departments in hospitals affiliated to Tehran University of Medical Sciences. A study was carried out in the emergency departments of five major teaching hospitals [affiliated to Tehran University of Medical Sciences] in Tehran, Iran by trained researchers using a valid and reliable questionnaire. The study included patients who had spent at least 10 hours in the emergency department, who were able to answer the questions without the need for an interpreter, did not have significant cognitive problems, and were well enough to answer the questions. The study questionnaire comprised five sections namely: nursing care, physician care, behavioral concerns, physical comfort and hoteling, and waiting time. The questionnaire was administered in secure and confidential conditions inside the emergency department and in the absence of the hospitals' medical and non-medical staff. Data were analyzed descriptively using SPSS 13. In all 153 patients were eternal into the study. After dichotomizing the state of satisfaction in each of the five dimensions, the highest dissatisfaction rates were observed in the following domains: nurses' explanation to patients [73.2%], giving information [54.2%], investigating complaints [40.6%], patient welfare facilities [54.3%], and being kept waiting to receive laboratory services [26.2%] respectively. Only 44% of the patients rated their general satisfaction with the hospital as good or very good. The findings indicate the need for measures to improve services for patients visiting the emergency department and to ensure quality of service

Cancer in ancient Iranian medical books

In medical history of different nations, there are numerous documents concerning cancer. The present study is an investigation in ancient books to determine the part that Iranian medicine has played in the recognition of cancer. 30 Iranian medical books mostly from 3rd to 13th centuries A.H. in a library search study were examined. The findings showed that cancer in ancient medical books of Iran has been categorized under [swellings] and classified as [solid tumor] and [cold swelling]. Like other diseases, the etiology of cancer has been related to four humours. Also the role of nutrition in cancer development has not been neglected. Concerning clinical manifestations, it has been discussed that cancer in early stages lacks clinical manifestations but with its progression gradually its symptoms and signs appear. Cancer was found to be more common in women and the most common organs involved were indicated as breast and uterus in women and pharynx, larynx, gut and genitalia in men. Cancer outbreak was reported in autumn. To differentiate cancer from other swellings, it has been recommended that all swellings must be viewed using clinical and physical examination. Concerning the prognosis of cancer, there was an agreement on its poor prognosis but some factors were considered important. Concerning the treatment of cancer, it was believed that although there is no complete cure, the treatment of cancer [medical management, surgery, diet] should be considered in its early stages. The findings from this study indicate that in ancient Iranian medical books cancer has been thoroughly investigated from different perspectives, some of which still have maintained their scientific merits