Prevalence and risk factors of alcohol and substance abuse among motorcycle drivers in Fars province, Iran.

PURPOSE: The aim of this present study is to investigate the prevalence of alcohol and substance abuse (ASA) and its relationship with other risky driving behaviors among motorcycle drivers. METHODS: This is a cross sectional study which is performed at Shiraz city of Iran. Data from motorcycle drivers were collected using a standard questionnaire in eight major streets at different times of the day. The data includes consumption of alcohol and other substances two hours before driving and some of the risky behaviors during driving. RESULTS: A total of 414 drivers with a mean ± SD age of (27.0 ± 9.3) years participated in the study. Alcohol or substance consumptions two hours before driving was significantly associated with risky driving behaviors such as using mobile phone during driving, poor maneuvering, and driving over the speed limit (both p < 0.001). It was also associated with carelessness about safety such as driving with technical defects (p < 0.001) and not wearing a crash helmet (p=0.008). CONCLUSION: Screening for alcohol and substance consumption among motorcycle drivers is an efficient way to identify drivers that are at a greater risk for road traffic accidents.

The prevalence and effective factors of crash helmet usage among motorcyclists in Iran.

BACKGROUND: Crash helmet plays an important role in protecting the deriver's head during crashes and reduces the rate of severe injuries and fatalities. Although it has been proved that wearing the crash helmet can save the deriver's life by around 42%; previous studies showed that the rate of wearing crash helmet has not been acceptable in Iran. Due to the huge number of motorcyclists on the roads in Iran, the use of crash helmet is an important area of research. The aim of this study was to assess the factors that could possibly relate to or affect the use of crash helmet by the motorcyclists. METHODS: This is an observational study on 414 motorcyclists in Shiraz, Southern Iran. All participants completed a questioner containing demographic features, crash helmet use, motorcycle license, and the reasons for using motorcycles. RESULTS: All the participants were males and aged from 16 to 64 years with mean age 27±9.28. The results of logistic regression model revealed that only the drivers who had motorcycle license (OR=2.73, C.I: 1.40-7.24), employed the motorcycle for reasons other than pleasure (OR=3.18, C.I: 1.42-7.37) and been driving for 10 or more years (OR=1.92 95% C.I: 1.12-3.30) had greater rate of wearing crash helmet. Interestingly, educational levels, age, and other demographical variables had no relationship with crash helmet usage. CONCLUSIONS: It is believed that in order to increase the rate of crash helmet use, it is necessary to enact obligatory requirement for driving license by motorcyclists and increase the legal age for motorcycle driving.

Stroke specific quality of life questionnaire: Test of reliability and validity of the Persian version.

BACKGROUND: The aim was to assess the reliability and the validity of the translated version of the stroke specific quality of life (SS-QOL) questionnaire in Iranian post-stroke patients. METHODS: This project was performed at the Shiraz University of Medical Sciences, Shiraz, Iran, between 12 April 2010 and 24 February 2011. The English version of the SS-QOL was translated into Persian by "forward-backward" translation, cognitive inquiring and cultural adaptation process. The reliability and internal consistency were measured by Cronbach's alpha coefficient. Validity was assessed using convergent and divergent validity through Spearman's correlation coefficient. RESULTS: Our study included 117 post-stroke patients, consisting of 57 (48.7%) men and 60 (51.3%) women. The mean age of the patients was 81.60 ± 7.52 (range 60-88) years. The Persian version of the SS-QOL proved reliable (Cronbach's α = 0.96). Internal consistency was excellent for both demographic and patients' clinical characteristics (Cronbach's α ≥ 0.70). The scaling success rates were 100% for convergent validity of each scale. Divergent validity for all 12 scales was considered acceptable, whereas each scale had a 100% scaling success rate for convergent validity. CONCLUSION: The Persian version of SS-QOL should be mentioned as a noteworthy instrument to specify different aspects of health related QOL of patients suffering stroke and hence that clinicians, researchers and epidemiologist can exploit it trustfully.

The Prevalence of Substance use and Associated Risk Factors Among University Students in the City of Jahrom, Southern Iran.

BACKGROUND: Substance use among college students in Iran is a serious problem. Determining the pattern of substance use among University students is an important issue for implementing prevention and treatment programs. OBJECTIVES: The present survey attempts to determine the prevalence of substance usage and associated risk factors among the students of Jahrom University of Medical Sciences and Islamic Azad University of Jahrom, Jahrom, Iran. PATIENTS AND METHODS: This cross-sectional study was carried out from December 2012 to February 2013 and included 1149 randomly selected students of two Jahrom universities. A standard questionnaire was used for data gathering. Data were analyzed using the SPSS version 15 for Windows. T-test and Chi-square T-test and Chi-square and Logestic regression tests were used for data analysis. RESULTS: Tobacco (28.3%), alcohol (13.0%), and cannabis and marijuana (5.2%) were the most common substances used by the students. The prevalence of substance use among the male students was significantly higher (OR: 1.5, 95%CI: 1.42 - 2.68, P < 0.001). The risk of at least single episode of substance usage was higher among the students which were living alone (OR: 3.03, 95%CI: 1.74 - 5.28, P < 0.001) The most important motivators for beginning substance use were curiosity, in 46.4%, and seeking pleasure, in 28.8%. CONCLUSIONS: Substance usage is considered as a risk factor for students' health among University students in Iran. Design of educational courses addressing the detrimental effects and dire consequences of substance usage could help to improve control programs. Universities could improve their drug abuse control programs by focusing on the high risk groups determined by relevant studies.

Determinants of poor outcome in patients with hepatitis A infection: a four-year retrospective study in Shiraz, Southern Iran.

There are 1.4 million estimated cases of hepatitis A every year worldwide. We aimed to detect the correlates of poor outcome in patients with hepatitis A virus (HAV) infection. In this four-year retrospective study, which was conducted in Shiraz, Southern Iran, data of all hospitalized HAV patients were analyzed by SPSS and STATA. Out of 110 HAV patients, 8 (7.3 %) developed hepatic encephalopathy, and 7 (6.4 %) died. The results show that 19 years of age is a cutoff level for predicting mortality, with a sensitivity of 42.9 % and specificity of 91.3 %, and with an area under the curve (AUC) of 0.595 (95 % CI, 0.309-0.881). Every one-year increase in age adds 3 % to the mortality rate from severe hepatitis A. The cutoff level of alanine aminotransferase (ALT) for predicting death is 1819.5 IU/L, with a sensitivity of 100 %, specificity of 68 %, and AUC 0.877 (95 % CI, 0.777-0.977). Every 100 IU/L increase in ALT is associated with a 0.1 % increase in the risk of death. Patients from large families (OR, 0.583, 95 % CI, 0.46-0.74) and those who are not the firstborn child of their family (OR, 0.287, 95 % CI, 0.146-0.564) have better outcome. Adult patients with hepatitis A who are first children, are from a small family, or have a very high level of ALT are more prone to a poor outcome of this infection. Public education and establishment of a national surveillance system for HAV and an HAV vaccination program for high-risk populations should be regarded among the priorities of the health system of Iran.

Mechanical thrombectomy for cerebral venous sinus thrombosis: a comprehensive literature review.

BACKGROUND: Endovascular treatment of cerebral venous sinus thrombosis (CVST) includes pharmacological and mechanical thrombolysis. METHODS: The authors searched the English literature on CVST from 1990 to 2012 for all case reports or case series of mechanical thrombectomy. RESULTS: A total of 64 patients were treated in all published studies. The techniques for mechanical thrombectomy included rheolytic thrombectomy with an AngioJet device (46.9%), clot retraction with the Penumbra system (4.7%), clot retraction with a Fogarty catheter (1.6%), clot retraction with a microsnare (3.1%), balloon venoplasty without stenting (18.7%), balloon venoplasty with stenting (4.7%), and an amalgam of techniques (18.7%). Nine (16.1%) patients died. At the most recent follow-up, 40 (62.5%) patients had no disability or minor disability and 7 (10.9%) patients had major disability. CONCLUSION: Randomized multiinstitutional clinical trials with larger number of participants are needed to sufficiently compare the effect of intrasinus thrombolysis and mechanical thrombectomy to standard-of-care anticoagulation therapy.

Perihepatic Packing versus Primary Surgical Repair in Patients with Blunt Liver Trauma; an 8-year Experience.

OBJECTIVE: To explore the pros and cons of early versus delayed intervention when dealing with severe blunt liver injury with significant hemoperitoneum and hemodynamic instability. METHODS: This retrospective cross-sectional study was performed at the Nemazi hospital, Shiraz, Southern Iran, level I trauma Center affiliated with Shiraz University of Medical Sciences. The study population comprised of all patients who were operated with the impression of blunt abdominal trauma and confirmed diagnosis of liver trauma during an 8-year period. All data were extracted from patients' hospital medical records during the study period. The patients' outcome was compared between those who underwent perihepatic packing or primary surgical repair. RESULTS: Medical records of 76 patients with blunt abdominal liver trauma who underwent surgical intervention were evaluated. Perihepatic packing was performed more in patients who have been transferred to operation room  due to unstable hemodynamics (p<0.001) as well as in patients with more than 1000 milliliters of hemoperitoneum based on pre-operative imaging studies (e.g. CT/US) (p=0.002). CONCLUSION: We recommend that trauma surgeons should approach perihepatic packing earlier in patients who have been developed at least two of these three criteria; unstable hemodynamics, more  than  1000 milliliters hemoperitoneum  and  more  than  1600 milliliters of intra-operative  estimated blood  loss. We believe that considering these criteria will help trauma surgeons to diagnose and treat high risk patients in time so significant hemorrhage (e.g. caused by dilatational coagulopathy, hypothermia and acidosis, etc.) can ultimately be prevented and more lives can be saved.

Common carotid intima-media thickness in patients with non-alcoholic fatty liver disease: a population-based case-control study.

BACKGROUND/AIMS: Metabolic syndrome is a well-known risk factor for atherosclerosis. Non-alcoholic fatty liver disease (NAFLD) has features of metabolic syndromes. This study aimed to investigate the association between NAFLD and atherosclerosis. METHODS: In a population-based study in southern Iran, asymptomatic adult inhabitants aged more than 20 years were selected through cluster random sampling, and were screened for the presence of fatty liver and common carotid intima-media thickness (CIMT), with abdominal and cervical ultrasonography, respectively. Those with fatty liver were compared to the same number of individuals without fatty liver. RESULTS: Two hundred and ninety individuals were found to have fatty change on abdominal ultrasonography, and were labeled NAFLD. Compared to normal individuals, NAFLD patients had significantly higher prevalence of increased CIMT (OR, 1.66; p<0.001). Those with hypertension (HTN), diabetes mellitus (DM), higher waist circumference (WC) and older ages had significantly higher prevalence of thick CIMT. Through adjusting the effects of different variables, we indicated that NAFLD could be an independent risk factor for thick common carotid intima-media (OR, 1.90; 95% CI, 1.17-3.09; p=0.009). It was also shown that age could be another independent risk factor for thick CIMT. CONCLUSIONS: Individuals with risk factors such as HTN, DM, and high WC are prone to develop atherosclerosis of the carotid artery. The presence of NAFLD should be considered as another probable independent factor contributing to the development of carotid atherosclerosis.

Non alcoholic fatty liver disease in southern Iran: a population based study.

BACKGROUND: Population based studies on prevalence and risk factors of NAFLD in Iranian population are few. The prevalence of NAFLD and non alcoholic steatohepatitis (NASH) in Iranians varies from 2.9% to 7.1% in general population and 55.8% in patients with type 2 diabetes mellitus. OBJECTIVES: To determine the prevalence and determinants of non alcoholic fatty liver disease (NAFLD) in a sample of adult Iranian general population. PATIENTS AND METHODS: This was a cross-sectional study being performed in Shiraz, southern Iran during a 10-month period from November 2010 to September 2011 through cluster random sampling of Iranian general population in Shiraz region. All individuals undergone anthropometric, blood pressure measurements, thorough medical history and physical examinations. Laboratory measurements included fasting blood glucose (FBS), lipid profile, complete blood count (CBC) and liver function tests. NAFLD was diagnosed by transabdominal ultrasonography. RESULTS: 819 subjects were included in this study among which were 340 males (41.5%) and 479 females (58.5%) with the mean age of 43.1 ± 14.1 years. NAFLD was diagnosed in 176 (21.5%) subjects. Patients with NAFLD were significantly older (P < 0.001), had higher proportion of male gender (P = 0.004) and had higher BMI (P < 0.001). They also had higher prevalence of hypertension (P < 0.001), high FBS (P < 0.001), high cholesterol (P = 0.026), high triglyceride (P < 0.001) and high waist circumference (P < 0.001). Taking all these together, patients with NAFLD had significantly higher prevalence of metabolic syndrome when compared to healthy subjects (P < 0.001). CONCLUSION: The prevalence of NAFLD in this group of Iranian adult general population is 21.5%. NAFLD in Iranian population is associated with male gender, old age, obesity, and features of metabolic syndrome.

Quality of life among Iranian patients with beta-thalassemia major using the SF-36 questionnaire.

CONTEXT AND OBJECTIVE Patients with beta-thalassemia major (ß-TM) experience physical, psychological and social problems that lead to decreased quality of life (QoL). The aim here was to measure health-related QoL and its determinants among patients with ß-TM, using the Short Form-36 (SF-36) questionnaire. DESIGN AND SETTING Cross-sectional study at the Hematology Research Center of Shiraz University of Medical Sciences, in southern Iran. METHODS One hundred and one patients with ß-TM were randomly selected. After the participants' demographics and disease characteristics had been recorded, they were asked to fill out the SF-36 questionnaire. The correlations of clinical and demographic factors with the QoL score were evaluated. RESULTS There were 44 men and 57 women of mean age 19.52 ± 4.3 years (range 12-38). On two scales, pain (P = 0.041) and emotional role (P = 0.009), the women showed significantly lower scores than the men. Lower income, poor compliance with iron-chelating therapy and presence of comorbidities were significantly correlated with lower SF-36 scores. These factors were also found to be determinants of worse SF-36 scores in multivariate analysis. CONCLUSIONS We showed that the presence of disease complications, poor compliance with iron-chelating therapy and poor economic status were predictors of worse QoL among patients with ß-TM. Prevention and proper management of disease-related complications, increased knowledge among patients regarding the importance of managing comorbidities and greater compliance with iron-chelating therapy, along with psychosocial and financial support, could help these patients to cope better with this chronic disease state.

Data coverage of a cancer registry in southern Iran before and after implementation of a population-based reporting system: a 10-year trend study.

BACKGROUND: Cancer registries help to decrease the burden of cancers by collecting accurate and complete data. We aimed to measure the completeness of coverage of information recorded between 2000 and 2009 in a cancer registry program in Fars province, southern Iran. METHODS: The cancer registry program run by Shiraz University of Medical Sciences was investigated in two periods: pathology-based data from 2000 to 2007 and population-based data from 2007 to 2009. Completeness of yearly coverage was measured as the number of reported cases of cancer in each year divided by estimated cases based on 107.3 new cases per 100 000 individuals. The percentage of complete data registration (patient's name, age, gender, address, phone number and father's name) and correct cancer encoding was calculated for each year and compared to the maximum acceptable error rate for each item. RESULTS: A total of 29 277 non-duplicate cancer records were studied. Completeness of coverage varied from 22.68% in 2000 to 118.7% in 2008. Deficiencies in patients' demographic data were highest for name in 2002 (0.09%), age in 2006 (2.36%), gender in 2001 (0.06%) and father's name in 2001 (52.5%). Incomplete address (99.7%) and missing phone number (100%) were most frequent in 2000, and deficiencies in encoding information were highest in 2008 (6.36%). CONCLUSIONS: The cancer registry program in Fars province (southern Iran) was considered satisfactory in terms of completeness of coverage and information about age. However, it was deficient in recording patients' phone number and address, and father's name. The error level for cancer encoding was unacceptably high. Enhancing hardware and software resources, education and motivation in all public and private sectors involved in the cancer registry program, and greater attention to epidemiological research are needed to increase the quality of the cancer registry program, including its completeness.

Time analysis of fatal traffic accidents in Fars Province of Iran.

OBJECTIVE: To analyze the time factor in road traffic accidents (RTAs) in Fars Province of Iran. METHODS: This study was conducted in Fars Province, Iran from November 22, 2009 to November 21, 2011. Victims'information consisted of age, sex, death toll involving dri- vers or passengers of cars, motorcycles and pedestrians, and site of injury etc. Accidents were analyzed in relation to hour of the day, season of the year, lighting condition including sunrise, sunset, daytime and nighttime. RESULTS: A total of 3 642 deaths (78.3% were males, and the ratio of males to females was about 3.6:1) were studied regarding their autopsy records. There was a steady increase in fatal accidents occurring at midnight to 15:59. The risk of being involved in a fatal traffic accident was higher for those injured between 4:00 to 7:59 than at other times (OR equal to 2.13, 95% CI 1.85-2.44). The greatest number of fatal RTAs took place in summer. Mortalities due to RTA during spring and summer were more pronounced at 20:00 to 23:59 and midnight to 3:59, whereas mortalities in fall and winter were more pronounced from 12:00 to 15:59. CONCLUSION: The high mortality rate of RTA is a major public health problem in Fars Province. Our results indicate that the time is an important factor which contributes to road traffic deaths.

Quality of life among Iranian patients with beta-thalassemia major using the SF-36 questionnaire / Qualidade de vida em pacientes iranianos com beta-talassemia maior usando o questionario SF-36

CONTEXT AND OBJECTIVE Patients with beta-thalassemia major (β-TM) experience physical, psychological and social problems that lead to decreased quality of life (QoL). The aim here was to measure health-related QoL and its determinants among patients with β-TM, using the Short Form-36 (SF-36) questionnaire. DESIGN AND SETTING Cross-sectional study at the Hematology Research Center of Shiraz University of Medical Sciences, in southern Iran. METHODS One hundred and one patients with β-TM were randomly selected. After the participants' demographics and disease characteristics had been recorded, they were asked to fill out the SF-36 questionnaire. The correlations of clinical and demographic factors with the QoL score were evaluated. RESULTS There were 44 men and 57 women of mean age 19.52 ± 4.3 years (range 12-38). On two scales, pain (P = 0.041) and emotional role (P = 0.009), the women showed significantly lower scores than the men. Lower income, poor compliance with iron-chelating therapy and presence of comorbidities were significantly correlated with lower SF-36 scores. These factors were also found to be determinants of worse SF-36 scores in multivariate analysis. CONCLUSIONS We showed that the presence of disease complications, poor compliance with iron-chelating therapy and poor economic status were predictors of worse QoL among patients with β-TM. Prevention and proper management of disease-related complications, increased knowledge among patients regarding the importance of managing comorbidities and greater compliance with iron-chelating therapy, along with psychosocial and financial support, could help these patients to cope better with this chronic disease state. .

CONTEXTO E OBJETIVO Pacientes com beta-talassemia maior (β-TM) vivenciam problemas físicos, psicológicos e sociais que levam à diminuição da qualidade de vida (QV). O objetivo foi determinar a QV relacionada à saúde e seus determinantes em pacientes com β-TM, utilizando questionário SF-36 (Short Form-36). TIPO DE ESTUDO E LOCAL Estudo transversal no Centro de Hematologia e Pesquisa em Universidade de Ciências Médicas de Shiraz, no sul do Irã. MÉTODOS Foram selecionados aleatoriamente 101 pacientes com β-TM. Após registro demográfico e características da doença, eles foram convidados a preencher o questionário SF-36. A correlação entre fatores clínicos e demográficos com escore de QV foi avaliada. RESULTADOS Havia 44 homens e 57 mulheres, com idade média de 19,52 ± 4,3 (variação 12-38) anos. Em duas escalas, dor (P = 0,041) e aspectos emocionais (P = 0,009), as mulheres apresentaram escores significativamente menores aos dos homens. Menor renda, baixa adesão à terapia quelante de ferro e presença de comorbidades foram correlacionadas com escores SF-36 significativamente menores. Esses fatores foram também considerados determinantes de piores escores de SF-36 em análise multivariada. CONCLUSÕES Mostramos que a presença de complicações da doença, a baixa adesão ao tratamento da terapia quelante de ferro e o baixo status econômico são preditores de pior QV em pacientes com β-TM. Prevenção e manejo adequado das complicações relacionadas com a doença, aumento do conhecimento dos pacientes sobre a importância do gerenciamento de comorbidades e ter maior adesão ao tratamento quelante de ferro, considerando também ...

Acceptance and rejection of influenza vaccination by pregnant women in southern Iran: physicians' role and barriers.

OBJECTIVE: Vaccination provides the most effective protection against maternal, fetal and neonatal complications of influenza infection. This study aimed to determine the uptake rate of influenza vaccination including 2009 pandemic H1N1 influenza and seasonal influenza vaccination and the reasons for acceptance or rejection among pregnant women. RESULT: Mean age of the 416 pregnant women enrolled in this study was 27.06 ± 5.27 y. Only 25 (6%) of 397 women had history of vaccination. Of 383 (92.06%) pregnant women who had rejected vaccination, 116 (30.28%) declared that they lacked information about influenza vaccination and 44 (11.48%) felt that they did not need vaccination. Concerns about the safety of influenza vaccination were reported by only 2 women (0.52%). Of the 25 (6%) pregnant women who were vaccinated against influenza, 15 (60%) accepted because of advice they received from persons other than physicians, 5 (20%) believed that influenza vaccination is necessary for everyone, and 3 (12%) accepted because of a history of frequent influenza virus infections in previous years. METHOD: This questionnaire based study was conducted at obstetrics and maternity hospitals affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. Pregnant women were interviewed individually and privately. SPSS was used for data analysis. CONCLUSION: Most of the unvaccinated and vaccinated pregnant women lacked sufficient knowledge about influenza. Education of pregnant women about influenza vaccination and encouragement from physicians may have a remarkable effect on turning poor compliance into high flu vaccination uptake among pregnant women.

Mycobacterium aurum keratitis: an unusual etiology of a sight-threatening infection.

Atypical fast-growing Mycobacterium species are usually identified after laser-assisted in situ keratomileusis, cosmetic surgeries, and catheter-related, pulmonary or soft tissue infections. We herein present the case of a 56-year-old man with purulent discharge, redness, and foreign body sensation in his left eye. He underwent two surgeries that partially controlled the infection but were not curative. Corneal transplantation was performed, and a biopsy of the excised cornea indicated Mycobacterium aurum infection, which was confirmed by polymerase chain reaction-restriction fragment length polymorphism analysis. This appears to be the first documented case of keratitis attributable to the non-tuberculous mycobateria M. aurum. The intractable extra-ocular progression of the disease in the absence of general signs or symptoms was notable. We suggest considering non-tuberculous mycobacteria among the probable causes of complicated keratitis or keratitis that does not respond to drug treatment, especially in regions where tuberculosis is endemic.

Mycobacterium aurum keratitis: an unusual etiology of a sight-threatening infection

Atypical fast-growing Mycobacterium species are usually identified after laser-assisted in situ keratomileusis, cosmetic surgeries, and catheter-related, pulmonary or soft tissue infections. We herein present the case of a 56-year-old man with purulent discharge, redness, and foreign body sensation in his left eye. He underwent two surgeries that partially controlled the infection but were not curative. Corneal transplantation was performed, and a biopsy of the excised cornea indicated Mycobacterium aurum infection, which was confirmed by polymerase chain reaction-restriction fragment length polymorphism analysis. This appears to be the first documented case of keratitis attributable to the non-tuberculous mycobateria M. aurum. The intractable extra-ocular progression of the disease in the absence of general signs or symptoms was notable. We suggest considering non-tuberculous mycobacteria among the probable causes of complicated keratitis or keratitis that does not respond to drug treatment, especially in regions where tuberculosis is endemic.

Helicobacter pylori infection in patients with epilepsy.

BACKGROUND: The possible role of Helicobacter pylori (HP) infection in extra-intestinal diseases has been suggested. The main purpose of this study was to determine the frequency of infection with HP in two groups of patients with epilepsy: patients with idiopathic generalized epilepsy (IGE) and patients with temporal lobe epilepsy (TLE), compared to healthy controls. METHODS: In this cross-sectional study a random sample of adult patients above 18 years of age with a diagnosis of IGE or TLE were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, from January 2009 through June 2011. A group of healthy individuals were included as control group. For all patients and controls a urea breath test (UBT) was requested. RESULTS: Thirty-four patients with IGE, 28 patients with TLE and 33 individuals as control were recruited. Positive UBT was observed in 21 individuals (61.8%) with IGE, 50% (14 patients) of patients with TLE and 72.7% (24 individuals) in control group. The difference between patients with IGE and control group was not significant (P=0.3). The difference between patients with TLE and control group was not significant either (P=0.068). CONCLUSION: The rate of HP infection was not higher in patients with epilepsy compared to healthy individuals. At the moment, there is not enough epidemiological data to support the role of HP infection in patients with either IGE or TLE.

Reducing Social Disparity in Liver Transplantation Utilization through Governmental Financial Support.

BACKGROUND: A high proportion of patients suffering from end stage liver disease are from low socioeconomic classes , which limits their access to liver transplantation as the most effctive treatment of this condition because of cost barrier. OBJECTIVES: one of the most challenging aspects of liver transplantation is its affordability and utilization by those who need it the most. PATIENTS AND METHODS: Since November 2005, Iran Ministry of Health had covered 100% of the costs of in-patient liver transplantation care. To determine the effects of this policy, patterns of utilization of liver transplantation were compared before and after implementation of the policy. Group one included 112 and group two included 120 individuals who received transplantation before (from early January 2003 to November 2005) and after (from November 2005 to the end of December 2007) the legislation entered into the effect, respectively. Socioeconomic characteristics of these patients were evaluated by data collected about house and car ownership, education level, employment status, and place of residence. RESULTS: Coverage of the costs allowed more illiterate and semiliterate people (P = 0.032) as well as more unemployed or unskilled workers to receive transplantation (P = 0.021). The number of transplantations also increased in children and geriatric age group. This legislation also led to greater countrywide regional coverage of indigent patients. CONCLUSIONS: This survey provides evidence that coverage of the costs by Ministry of Health was effective in reducing social discrimination in utilization of liver transplantation, and narrowed the gap between low and high socioeconomic classes in Iranian society.

Diffuse intracerebral calcification in a beta-thalassaemia major patient with hypoparathyroidism: a case report.

Beta-thalassemia major is a complex medical problem found worldwide. Endocrinopathies are some of the most frequent dysfunctions found in these patients. Iron overload in different organs is responsible for multiple endocrine complications particularly in the absence of adequate chelation therapy. One of the most prevalent endocrine complications of thalassemia major is hypoparathyroidism. It can cause cerebral calcifications in the basal ganglia but seldom outside of the extrapyramidal system. There are few studies about intracerebral calcification due to hypoparathyroidism in patients with thalassemia major. We report the case of a 14 year-old girl who came to our Center with the chief complaint of a generalized tonic-clonic seizure. The patient was known to have beta-thalassemia major since she was 9 months old. Computerized tomographic scan of the brain was done which showed diffuse intracranial calcifications in deep white matter, posterior fossa, basal ganglia and both thalami. Laboratory and neuroimaging assessments revealed the diagnosis of hypoparathyroidism. We strongly recommend periodic assessment and tight control of serum calcium level in all patients with betathalassemia major. Prompt treatment with oral calcium supplements and an active form of vitamin D can prevent hypoparathyroidism and its neurologic complications. Comprehensive evaluation and treatment of other endocrinopathies in accordance with hypoparathyroidism is suggested.