Iranian Journal of

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Background and Objectives: Anaphylactic reaction is one of the most important transfusion anaphylactic reactions in medicine. During transfusion if Individuals with IgA deficiency take blood which containing IgA, they would suffer from severe allergic reaction. Since there is a little known about this in different ethnic groups in Iran we have decided to evaluate this issue in Sistan & Baluchestan province in Iran. Methods: During one year, blood samples were collected from 3837 volunteer blood donors. Then the serum samples were tested for IgA titer by nephlometry and SRID techniques.
Results: According to our results only, one donor (0.026%) was found to have IgA less than 5mg/dl and 34(0.9%) cases had IgA: 5-30 mg/dl while 3798(99%) had IgA more than 30mg/dl.
Conclusions: With regards to very low prevalence of IgA deficiency in blood donors in Southeast part of Iran, it seems that anaphylactic reactions most likely be due to other factors in the individuals that receive blood products.

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Background & Objectives: oxygen free radicals have been implicated as mediators of tissue damage in RA patients. This study was aimed to find the effects of vitamin A, C and zinc supplementations on oxidant–antioxidant, inflammatory and clinical indices in inactive RA patients.
Methods: We designed a randomized controlled trial. Forty nine (49) patients were randomly allocated in two groups group I received their conventional treatment plus 300 mg vitamin C, 5 mg Zinc daily and 25000 IU vitamin A every other day for 12 weeks, group II received their conventional treatment only for the same duration. Disease activity (using the rheumatoid arthritis disease activity index (RADAI) score), biochemical indices [malondialdehyde (MDA), total antioxidant capacity (TAC)] and inflammatory markers [erythrocyte sedimentation rate (ESR), c-reactive protein (CRP)] was evaluated before and after 12 weeks.
Results: Serum concentration of MDA and RADAI score (P<0.0001) and ESR (P=0.033) were significantly decreased and TAC levels (P<0.0001) were significantly increased in the first group in comparison to second group after 12 weeks. However, there were no statistically significant differences in serum CRP concentration of two groups (P>0.05).
Conclusions: This study indicates that adding antioxidants as supplementations with conventional medications in inactive RA patients plays an important role in improving oxidative stress and decreasing disease activity and inflammatory status.

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Background & Objective: A growing body of literature suggests that healthy and well-nourished women can safely participate in most forms of physical activity during pregnancy. The objective of this study was to determine the performance of pregnant women about exercise during pregnancy in Tehran.
Methods: we performed an analytical cross-sectional study on 400 pregnant women referred to prenatal care units in Imam Khomeini hospital. Information was obtained through a questionnaire designed to measure practice. Data analysis was performed by the Spss v 13.5 software package. We calculated means and standard deviation for practice in terms of independent variable and applied ANOVA test and regression model for detection of association between variables.
Results: The mean of practice scale was (14.23+/- 1.76). We observed significant association between performance of pregnant women regarding exercise and their occupation, education status and education status of their husbands (P<0.001).Education status of husbands had a significant predictive effect in regression model (p<0.001).
Conclusions: It seems that the majority of pregnant women, who exercise during pregnancy, do not follow the principles correctly therefore their performance is not adequate almost in all domains.

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Background & Objectives: Cytomegalovirus (CMV) is a one the cause of congenital illness and disability, including hearing loss and mental retardation. CMV is a herpesvirus which establishes a persistent life-long infection. Since the prevalence of antibodies against the virus varies in different geographical areas in the world, we decided to identify the seroepidemiology of CMV infection.
Methods: A descriptive study was conducted among 360 volunteer asymptomatic healthy female students in Islamic Azad University of Kazeroun. The men age of subjects was 20.8 years. For serological studies five (ml) of blood sample was collected and the serum was isolated by centrifugation. Enzyme linked immunosorbent assay (ELISA) was used for determination of immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies of CMV. Finally the results were analyzed by statistical methods.
Results: Overall, CMV-IgG antibody was positive in 340 persons (94.4%) out of 360 subjects and they have a previous infection. However, Only four persons (1.1 %) were determined to have IgM antibody. Also we couldn’t find any significant difference concerning their fields of study and their residency (p>0.05).
Conclusions: With considering the high rat of CMV infection rate in young female, it is suggested to have appropriate preventive programs for women particular in susceptible groups.

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Background and objective: Cigarette smoking in adolescent population seems a major public health issue. The goal of the present study was to identify the effect of socio-personal factors on transitions in the adolescent smoking.
Methods: A total of 1785 students were assessed twice during 12 months. with respect to stage of change. The predictor variables were measured when the students were in the 10th grade. Logistic regression was used to predict different smoking stages at grade 11.
Results: At the end of follow-up, 14.3 percent of non-smokers have had smoking experiment, and 16.5 percent of smokers have showed to be the regular smokers. Among non smokers, using alcohol, friendship with smoker group were predictors of being regular smokers.
Conclusion: Smoking prevention program should begin in adolescent age group.

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Background & Objectives: The aim of this study was carried out to compare knowledge, attitude and practice of urban and rural households towards osteopenia and osteoporosis in Golestan, Sistan & Balouchestan and Boushehr provinces in Iran.
Methods: single-stage cluster sampling was used. The questions about knowledge about, attitude toward and practice of nutritional factors related to osteopenia and osteoporosis were asked by a structured interview.
Results: A total of 2306 households have been selected as overall sample size. Knowledge level of urban households about calcium as a preventive factor of osteoporosis & osteopenia was more in Sistan & Balouchestan, Golestan and Boushehr provinces. Knowledge level of urban households about calcium food courses: (Milk, Yogurt, Cheese and Dairy alternatives) was also better than that of rural habitants (P<0.01). Urban residents' attitude toward osteoporosis compared to rural residents was better (P 0.01>). Consumption of pasteurized milk had been paid more attention in urban households (P<0.001). The difference of daily milk intake in rural and urban households with pregnant or lactating women was not significant. Exposure of infant to sun as preventive factor was not satisticaly significant between rural and urban habitants.
Conclusion: It is concluded that the level of knowledge, attitude and practice of rural households toward osteoporosis and osteopenia was weaker than urban households.

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Background & objectives: In the management of crush syndrome, the way of treating compartment syndrome is controversial. The aim of this study was to evaluate the outcomes of compartment syndrome treatment after Bam earthquake.
Methods: Clinical and laboratory findings of all fasciotomized patients in Bam earthquake were analyzed. Then nonfasciotomized patients with same characteristics were selected and the outcomes of two groups were compared.
Results: Fasciotomy for 107 injured out of 2962 hospitalized patients, was performed (46% female). Mean age of fasciotomized patients was 27.4±9.7 years (min=10, max=65 year). There were not significant differences in the final outcome of two groups with the same clinical, biochemical and demographic characteristics.
Conclusions: Fasciotomy for 107 injured out of 2962 hospitalized patients, was performed (46% female). Mean age of fasciotomized patients was 27.4±9.7 years (min=10, max=65 year). There were not significant differences in the final outcome of two groups with the same clinical, biochemical and demographic characteristics.

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Background & Objectives: Medical Tourism has been recently paid more attention. Individual practitioners and medical organizations must be able to provide accurate information about this rapidly evolving trend. Since there has been little known about this issue, we decided to assess the knowledge about and attitude towards medical tourism in Rafsanjan, Iran.
Methods: A questionnaire including XXX questions were completed by Rafsanjan Medical University staff. All information was analyzed by SPSS software.
Results: Only 8.3% of individuals sated that they studied some articles about Medical Tourism, and only 14.7% of them had deal with these kinds of patients. The majority of participants (80.7%) hadn’t had any idea about the quality of medical expenses by Medical Tourists. Mainly (68.7%) believed that development of Medical Tourism in Iran would not have any bad social consequences and 62% believed that its development in Iran could improve the knowledge of Iranian doctors. The majority (67.3%) agreed to arrange for inviting tourism to Iran in order to use of Medical Tourists and 54.3 of them believed that development of Medical Tourism could improve treatment of Iranian patients.
Conclusions: The knowledge of participants seems is very low therefore appropriate educational programs should be tailored by responsible organizations in Iran. However medical staff’s attitude towards medical Tourism seems is very positive which indicates having necessary potential for any activity in this regard in future.

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Background and objective: The significance of knowledge transfer and research utilization for health care decision makers in developed and developing countries have been paid more attention recently. Literature emphasizes that nursing practice should be based on utilizing of research. The aim of this study is to identify barriers of research utilization in Iranian clinical nurse’s practice.
Methods: The Funk Research Utilization Barriers Questionnaire including 29 items in 4 domains (organization barriers and limitations, quality of research, nurses’ values, awareness and skills and communication of research) was employed in this study.
Results: Three main barriers to research utilization were identified: 1)"the nurse does not have time to read research", 2)"the nurse does not feel she/he has enough authority to change patient care procedures", and 3)"the facilities are inadequate for implementation".
Conclusion: Considering the organizational barrier, it is recommended that academic organizations should support and adopt to utilize research findings particularly in nursing practice in Iran.

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Background & Objective: Because of uncertainty in interpretation of some tests for diagnosing TB, decision making for the tuberculosis treatment is based on multiple diagnostic tests. This study was conducted to assess the accuracy of Quanti FERON-TB Gold test in tuberculosis diagnosis.
Methods: The study was carried out on 30 cases and 46 controls. Statistical indices of sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios, odds ratio and Receiver Operating Characteristics (ROC) curve were estimated.
Results: Sensitivity of QFT-G was 90.0% (95% CI=73.0-97.6), specificity 95.7% (95% CI=83.8-99.3), positive predictive value 93.1% (95% CI=76.3-98.9), negative predictive value 93.6% (95% CI=81.3-98.4). The area under ROC curve was 0.942 (95% CI=0.88-1.00), that significantly differed from chance diagonal area (P<0.0001). The optimum cut point for the Quanti FERON-TB Gold test was 0.35 IU/ml, with sensitivity of 0.90 and specificity of 0.957.
Conclusions: The Quanti FERON-TB Gold test displayed good validity indices in this study. Since the utility of this test has a high cost therefore this test would not be offered for routine tuberculosis detection. It suggested that this test are applicable for smear and culture negative tuberculosis, child tuberculosis, and assessment of TB contact tracing.

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Background & objectives: Increasing the rate of cesarean in recent decades is a noticeable sign which has been interested to look at some possible medical, psychological and social determinants. The aim of this study was to determine trend of cesarean during 1998-2007 and evaluation of some social factors in Damghan, Iran.
Methods: We used a case-control study by direct interview with mothers in health centers of city. A total of 120 cases (delivered by cesarean method) and 90 controls (delivered by natural method) were selected. For estimating of trend we used all medical files in Damghan maternity hospital between 1998-2007.Statistical analysis was performed in SPSS (Ver16) by descriptive and analytical (Chi-square, ANOVA and logistic regression) methods.
Results: A total of 12200 deliveries were registered during 1998-2007 and 51.7 percent of them were cesarean. From 1999 to 2003 years there is an increasing trend and most frequency of cesarean was in 2006 year (53.5%). Mean age, education, occupation, number of delivery, husband occupation, number of children and residency area was not significant between two groups. But from social factors, mother's education from diploma and higher, recom

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The popularity of qualitative research in the health sciences is steadily increasing. However individual qualitative research, alone, is unable to provide a comprehensive and broad understanding of the phenomenon under study. This may be the reason why the results of these studies are uncommonly used by health policy makers. Meta-synthesis is a method in which the results of a body of qualitative research are aggregated in order to produce a new and comprehensive interpretation of the studied phenomenon, in such a way that the final result still represents and includes the findings of the original studies. The lack of a comprehensive article in Farsi language in this field, encouraged the authors to write this paper to introduce this method and explain some of its essential components to familiarize health professionals, including researchers and students, with meta-synthesis. In this article, the following components of meta-synthesis are described: the definition, the necessity and the how-to of meta-synthesis a determining research question, the selection and analysis of the original studies, and lastly, meta-synthesis conductors.

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Background and objective: The nested case-control study has become popular as an efficient alternative to the full-cohort design. This study compares the results of a nested case-control analysis approach with the full cohort analysis.
Methods: A cohort of 276 subjects (new cases from a TB registry) was used for this study. Cox Regression model was used for the full cohort analysis. In order to do the nested case-control analysis, for each death, three random controls were selected from those who did not suffer from the outcome at the time of the outcome took place. Case control data was analyzed by the conditional logistic regression model.
Results: Results from both cohort and nested case-control analyses show that treatment group is the only variable that affects on the outcome. Gender, place of residence, and age has no effect on the outcome. For binary exposure variables with trivial effects (e.g. Gender and place of residence), the relative efficiency of nested case-control study design is approximately 75%.
Conclusion: Results of this study show that nested case-control study is not only an easy and cost-effective method for data analysis but also is as robust as cohort analysis in rate ratio and its variance estimation.

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Background & Objective: Physical activity is important for the health of all individuals, however, the determinants of physical activity behavior for elderly remain unexplored in Iran. The purpose of this investigation was to explore a range of factors that influence participation in physical activity for a group pf elderly people in Tehran in 2008.
Methods: This was a population-based study. Structured interviews with a valid questionnaire were employed for this survey. It was carried out on four hundred members of Healthy Association in Tehran. Multistage sampling was used.
Results: The mean age of participants was 64.07 ± 4.49. The prevalence of a sedentary lifestyle among elderly fifty-three (53%) estimated. The prevalence across the stages was as follows: 30.25% in pre contemplation, 12.75%in contemplation, 27.25% in preparation, 6.25% in action and 23.5% in maintenance. Inactive participants perceived that their laziness prevented them from being physically active. Meeting friends was the most important facilitator for participating in physical activity. The individuals who married, younger, lower body Mass index, having no chronic disease, and those with past history of exercise were more likely to adopt, initiate and maintain regular physical activity. Regression analysis showed that the greater knowledge of physical activity, higher Perceived health benefits, more Self efficacy were associated with physical activity.
Conclusion: Knowing the facilitators and barriers factors of physical activity in elderly would help to implement any future intervention for this group of people.

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Background & Objectives: Mental health is one of the most important public health issues, and it has major contribution in decreasing global burden of diseases .the objective of this study was to estimate the point prevalence rate of mental disorders in the population aged 18 years and over in Kashan city in 2009.
Methods: A classified- randomized sampling method was used. The General Health Questionnaire and clinical interview were employed to determine of mental disorders. data were analyzed by using Spss v. 16 and OR, and Chi-square test.
Results: The overall prevalence rate of mental disorders in Kashan was estimated (29%) (Female= 35/5%). The most prevalent disorders were mood disorders and anxiety disorders (9/3%) and (4/7%) respectively. In total five hundred-five (505) individuals with mental disorders, 32.1% had mood disorders, 25.6% had anxiety disorders, 4.2% had psychotic disorders, 3.4 % had neurological disorders, 3.4% dissociative disorders and 23.7% had other disorders. In this study 7.8% of subject had one mental disorder at least. The prevalence rate was high in people aged 56-65 years (35/8%) and widow (35/8%), illiterate (42/8%) and unemployed (38/8%). There were statistically significant differences between genders, education, and occupation and marital status.
Conclusion: Mental disorder has a priority for any intention intervention by health policy makers. It should be taken into account for any future agenda by ministry of health.

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Background & objectives: Cutaneous leishmaniasis (CL) is an endemic disease in district of Bam. It has created considerable concerns by people and health authorities. The objective of this study was to assess the effect of the earthquake and costs of prevention on CL prevalence after earthquake
Methods: This research is based on a natural intervention, in which the information related to the costs and prevalence of CL were collected and analyzed three years after the earthquake (2006-2008) and then compared with similar data three years before the earthquake (2000-2002) as control group.
Results: the earthquake increased the CL prevalence approximately 5.2 fold, although the cost of prevention had no significant effect on control of disease. The average cost of prevention was determined to be two US dollars per capita during the years after the earthquake. It figures up an overall estimation of 600000 US dollars for the three years after the earthquake. Meanwhile the cost of prevention before the earthquake was determined less than 5% comparing to after earthquake.
Conclusions: The findings of this cost-analysis showed that the current and conventional methods of CL prevention seem not useful. It could be concluded that current preventive measures such as spraying and impregnated bed nets particularly in natural disasters would have no effect on control of disease. Further researches are needed to find out the best method of prevention of CL disease. At present, it seems that early case-finding and prompt treatment of cases would be a proper method to control anthropometric CL .

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Methods: Thirty female Wistar rats were randomly allocated to three dietary groups: a standard diet (containing soy bean-oil), diet containing fish oil and diet containing mixed oil which was designed based on Iranian population fatty acid intake. Dams in each group were fed one of the diets during pregnancy and lactation and the pups were also weaned onto the same diet. Fasting serum glucose (Photometry) and insulin (ELISA) in pups were assessed and insulin sensitivity calculated on puberty.
Results: Fasting serum insulin in fish oil-fed group was significantly less than two other groups (P=0.018) and insulin sensitivity in fish oil-fed rats was significantly more than two other groups (P=0.002).
Conclusions: It seems a diet containing fish oil (rich in long chain omega-3 fatty acids) causes more insulin sensitivity comparing to diet containing soy bean oil (rich in omega-6 fatty acids) and diet with Iranian population fatty acid intake pattern (rich in saturated fatty acids).

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Background & objectives: Cardiopulmonary bypass often causes a stress hormonal response with subsequent changes in hemodynamic and organ perfusion. Human studies involving cardiopulmonary bypass have shown that very low doses of ketamine can attenuate inflammatory and stress markers, without adverse effects. The aim of this study was to investigate whether low dose infusion of ketamine have hemodynamic stability effect in coronary artery bypass surgery.
Methods: In this double blind-controlled trial, 50 patients undergoing on-pump CABG were randomly assigned to receive either 1.25mcg/kg/min of ketamine infusion (Ketamine group, n=25) or normal saline infusion (Control group, n=25) during 48 hours after induction of anesthesia. hemodynamic measurement including blood pressure, heart rate, central venous pressure, cardiac output, cardiac index, systemic venous resistance, arterial blood gas and lactate were measured previous to induction (T1), 4 h, 24h, and48h after the surgery (T2,T3 and T4). The data were evaluated with using of variance analyzing test and repeated measurement.
Results: There were significant interaction effect between time (pre operation, 4, 24 and 48 hours after operation) and group of study (ketamine and placebo) in assessment of systolic blood pressure (p=0.0001), diastolic blood pressure(p=0.0001), heart rate (p=0.004), central venous pressure (p=0.0001) and lactate (p=0.035). These indicate that ketamine caused decrement in tissue perfusion. Those interactions were not statistically significant for other parameters (p>0.05).
Conclusions: low dose ketamine during and 48 hours after operation not only didn`t show hemodynamic stability effect but also decreased tissue perfusion slightly.

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Background & Objective: Refractive errors (myopia, hyperopia and astigmatism) could lead to an impaired quality of life affect a large proportion of the population worldwide, irrespective of age, sex and ethnic group. Such refractive errors can be easily diagnosed, measured and corrected with spectacles or other refractive corrections to attain normal vision. Since there is paucity of information in school children in Iran we aimed to investigate the distribution pattern of refractive status and prevalence of refractive errors in school-age children in Shiraz
Methods: A random sampling strategy in geographically defined clusters was used to identify children aged 6-15 years in Shiraz between 2008-2209. We carried out a school survey and actual eye examinations, including visual acuity measurements, stereopsis examination, anterior segment and eyeball movements, fundus examinations, and cycloplegic retinoscopy with 1% cyclopentolate.
Results: Of 3065 selected individuals, 2683 were participated in the study (response rate 86.6%). According to cycloplegic refraction, 4.85% (95% (Cl), 3.52 to 6.16) of the primary and middle school students were myopic and 4.64% (95% Cl, 3.52 to 6.19) were hyperopic. For high school students, these rates were 22.19 and 11.4% respectively. Myopia and hyperopia were shown to be correlated with age. Prevalence of anisometropia, amblyopia and strabismus were 2.51%, 2.31(95%CI 1.51-3.11) and 1.83% (95%CI 1.15-2.50).
Conclusion: Compared to other published reports, the rate of myopia in the school children of Shiraz seems relatively high.

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Background & objectives: Personel who reguraly practice invasive procedures such as blood sample collection are particulary at risk to percutanous injuries. Needle stick injuries present the single gerates risk to medcial personnels. This sudy was undertaken to analyze the problem of needdle sticks injuries among health care workers at teaching hospitals in Urmia in 2008 year.
Methods: This cross-sectional study was conducted among 400 personals of Urmia teaching hospitals. A structured questionnaire was used to interview the study participants at their work place. Participants were asked to recall needle stick injuries in the preceding 12 months. Factors such as work experience, type of procedure, action taken following injury etc were also studied. The samples were selected by using simple random sampling in every hospital. The data were analyzed according to aims, by using Descriptive and analytical method. پ
Results: Around 25% (107/400) of the Health care workers had experienced a needle stick injury in the last six-months. Needle sticks injuries in females and male was 28% and 24% respectively. Most of the injuries created by needle (47.3%) and anjiocat needle (19.9%).
Conclusions: The results of this study show that the prevalence rates of needle stick injuries are a major risk in hospitals personnel. Therefore there is a need at the hospital level to have a uniform needle stick injuries policy covering safe work practices, safe disposal of sharps, procedures in event of needle stick injury, training including pre-employment training monitoring and evaluation of needle stick injuries and procedures for reporting needle stick injuries. >