Deadly rural road traffic injury: a rising public health concern in I.R. Iran

The 5[th] Iran National Development Plan, 2011-2015, has emphasized on expansion of rural asphalt roads. This article aims to illustrate the trend of deaths caused by rural road traffic crashes [RTCs] and its association with length of the rural roads in Iran. We carried out a retrospective analysis on secondary data for the period from 2005 to 2010. The Iranian Forensic Medicine Organization, High Commission for Road Safety and Iran's Statistical Center were the sources for the number of RTC death, length of the road and population data, respectively. Number of RTC deaths in rural roads increased from 1,672 in 2005 to 2,206 in 2010. This was associated with expansion of the rural asphalt roads [P = 0.04]. The construction of urban asphalt roads was also on an increasing trend, but the number of traffic deaths in these roads decreased from 26,083 in 2005 to 21,043 in 2010. Adjusted for 100,000 populations, the number of traffic deaths in urban roads showed a decrease from 37.0 to 28.0, while this number increased from 2.4 to 2.9 in rural roads during the study period. Although expansion of rural roads would contribute to economic development in rural areas, it exposes people to risk of severe RTCs if effective preventive actions are not taken. To prevent this threat, the Iranian policy makers need to take the followings into consideration: Public awareness, improving the safety of roads and vehicles, law enforcement, increasing coverage of police and Emergency Medical Services

Concurrent mobile and in situ types of right heart thrombi

Right-sided heart thrombus is a life-threatening condition that necessitates immediate therapy. Detection of right-sided heart thrombus is usually via transthoracic echocardiography. Generally, thrombolysis is considered a treatment of choice, but there is currently no consensus about the optimal therapeutic choice. We present a case of multiple right atrial thrombi with concurrent mobile and broad-based in situ thrombi in a patient with a history of chronic obstructive pulmonary disease, which was completely resolved by thrombolysis following a failed Heparin infusion. The patient was sent home in good clinical condition and was stable at 3 months' follow-up

Thematic analysis of Iranian female adolescents' perceptions about HIV/AIDS: a qualitative study

HIV/AIDS continues to be a major global health problem. The aim of this study was to evaluate common opinions and beliefs about HIV/AIDS among Iranian teenager girls. This Qualitative study [face-to-face interviews with tape recording] was conducted among fifty female teenager school students inUrmia-Iran. The thematic analysis indicated the main information sources for HIV/AIDS among teenage girls to be their mother and teachers. The participants had little concern about the dissemination of HIV/AIDS in Iran. Using a common syringe is mentioned as the main risk factor for HIV transmission. There were some misconceptions about the at-risk group among teenage girls. Considering the misconceptions among the teenage girls, their beliefs should be reformed and reorganized in order to reduce the risk of exposure to HIV. The best practice is training life skills in the school level

effect of acupressure on nausea and vomiting after cesarean section under spinal anesthesia

Postoperative nausea and vomiting [PONV] is one of the most common postoperative complications. Aside from pharmacological interventions, other complementary healing modalities have been introduced to assist patients in decreasing PONV and improving postoperative outcomes. This study examined acupressure as a safe complement to the more traditional approach of using drugs to prevent and/or relieve nausea and vomiting in the Cesarean section [C/S] under spinal anesthesia. In a prospective randomized clinical trial, 152 patients who were candidate for elective C/S under spinal anesthesia were evaluated in two groups [acupressure vs control groups]. Subjects in the acupressure group received constant pressure by a specific wrist elastic band [without puncture of the skin] on the Nei-Guan acupuncture point, 30 min prior to spinal anesthesia. The incidence of PONV was assessed during the surgery, at recovery room and at 1[st], 2[nd] and 3[rd] two hours after the surgery. Significant differences in the incidence of the post-operative nausea and vomiting were found between the acupressure and control groups, with a reduction in the incidence rate of nausea from 35.5% to 13.2%. The amount of vomitus and the degree of discomfort were, respectively, less and lower in the study group. In view of the total absence of side-effects in acupressure, its application is worthy. Our study confirmed the effectiveness of acupressure in preventing post-operative nausea and vomiting, when applied 30 minutes prior to surgery

Identifying the non-recurrent laryngeal nerve: preventing a major risk of morbidity during thyroidectomy

Non-recurrent laryngeal nerve [NRLN] is a rare anomaly which is reported in 0.3%-0.8% of people on the right side and in 0.004% [extremely rare] on the left side. Damage to this nerve during the surgical procedure may lead to severe iatrogenic morbidity and should therefore be prevented from being damaged. The best way to avoid this damage to the nerve is to identify the nerve with a systematic diligent dissection based on usual anatomical landmarks and awareness about the possibility of their existence. Hereby, we are going to present a 26-year-old woman, a case of NRLN on the right side which was identified during thyroidectomy. The nervous anomaly was accompanied with vascular abnormality which was confirmed by computerized tomography [CT] angiography, post-operatively

Evaluation and cost analysis of national health policy of Thalassaemia screening in west-Azerbaijan province of Iran

Thalassaemia is one of the most common Mendelian disorders in Mediterranean area. Iran has about 26,000 Thalassaemic patients, so it is one of the most affected countries. The aim of this study was to evaluate the screening program and cost analysis of Thalassaemia prevention program in West-Azerbaijan province of Iran. This study evaluated the efficacy of Health system's Thalassaemia prevention program with a sensitivity analysis for its costs. The second five years of the program was evaluated. The economic burden of Thalassaemia is determined by the birth prevalence of the affected infants and the cost that is accrued to treat the infected individuals and was compared with the total cost of screening the couples for thalassemia trait. The average incidence rate of major Thalassaemia was 19.8 per 100,000 live births and mean coverage rate of program was 74%. The rate of canceling the marriage among carrier couples was 53%. Cost analysis showed that the cost of screening and prenatal diagnosis program was much lower than the cost of treatment in potential thalassaemic patients. The prevention program of Thalassaemia including a premarital and pre-natal screening in west Azerbaijan province is demonstrated to be cost-effective. Taking some actions in order to increase the coverage of pre-marital screening, providing prenatal diagnosis in private and public sector, complete insurance coverage for the high-risk couples to perform the investigations more easily, were recommended

impact of stepwise stent deployment on the angiographic and clinical outcome of coronary angioplasty in the setting of an acute myocardial infarction

To detect a reduction in the incidence of no-reflow, and a possible improvement in angiographic and clinical outcome after stepwise stenting in comparison with conventional method in the percutaneous coronary intervention [PCI] of patients with anterior ST elevation myocardial infarction. Between March 2007 and December 2009, patients with anterior acute myocardial infarction [AMI] treated with streptokinase less than 6 hours from presentation who underwent early PCI were enrolled in this multicenter randomized clinical trial. The study was carried out in the Cardiology Departments of Valiasr Hospital of Zanjan, Imam Reza, and Shahid Madani Heart Hospitals, Tabriz, Iran. Four hundred and three patients were enrolled in this study. Patients were randomly divided into 2 groups: Group I [n=202] with stepwise stent deployment [SSD], and Group II [n=201] with routine conventional stent deployment [CSD]. The patients' mean age was 57.7 +/- 10.7 years. After PCI, thrombolysis in myocardial infarction myocardial perfusion grade [TMPG] 0/1, suggestive of no-reflow was significantly higher in CSD group [p=0.0001]. In hospital based, death occurred in 15 patients [7.5%] from CSD group while 4 [2%] from the SSD group [p=0.01]. The TMPG was also significantly higher in SSD group [average 2.32 +/- 0.18] compared with CSD group, [average 1.66 +/- 0.24] [p=0.0001]. Conventional stenting technique was an independent predictor of no-reflow in multivariate logistic regression analysis [hazard ratio - 1.43; 95% confidence interval: 1.15-1.73; p=0.01]. The SSD was associated with improved angiographic reperfusion indices and reduced mortality in early PCI for AMI

Seroprevalence of herpes simplex virus-2 in kidney transplant recipients: a single-center experience

Viral infections are a real threat in kidney transplant recipients because of their immunocompromised condition. This study aimed to evaluate herpes simplex virus-2 [HSV-2] seropositivity among kidney transplant recipients. Serum samples of 91 kidney transplant recipients from Urmia, Iran, were examined serologically for antibodies against HSV-2 using an enzyme-linked immunosorbent assay. The mean time from transplantation at HSV-2 testing was 5.04 +/- 4.45 years. The anti-HSV-2 immunoglobulin G antibody was positive in 5.4% of the kidney transplant recipients. Seropositive patients did not present any clinical manifestations of genital herpes infection. There was no association between HSV-2 seropositivity and age, gender, history of hemodialysis and transplantation, blood transfusion, or immunosuppressive regimen. Seroprevalence of HSV-2 is not high among our kidney transplant recipients. However, it remains a source of concern, considering the compromised immune system in this specific population

Gingival enlargement and its risk factors in kidney transplant patients receiving cyclosporine A

Gingival enlargement is one of the most cumbersome complications of cyclosporine A. It affects patient's life style by impairing the appearance and function of masticatory tract. This study was conducted on a sample of Iranian kidney transplant recipients to determine the frequency and risk factors of cyclosporine-induced gingival enlargement. A total of 200 kidney transplant recipients [mean age, 39.7 +/- 13.2 years] were enrolled in this study. All of the participants were receiving cyclosporine for at least 12 months prior to the study. Factors including age, gender, cyclosporine dose, serum concentration of cyclosporine, duration of immunosuppressive administration, plaque, and gingival indexes were evaluated. Seventy kidney transplant recipients [35%] showed various degrees of gingival enlargement. Serum cyclosporine concentration and the intensity of gingival enlargement [McGraw index] had a significant correlation [r = 0.35, P < .001]. Multiple regression analysis revealed an independent association between gingival enlargement and either serum concentrations of cyclosporine and plaque index [P < .05]. The other variables failed to show a significant relationship with gingival enlargement. The prevalence of cyclosporine-induced gingival enlargement in our patients seems to be almost greater than the prevalence reported in previous studies. There was a significant relationship between cyclosporine immunosuppressive treatment and gingival overgrowth in Iranian kidney transplant recipients