Payavard Salamat

The Study of prevalence of Hypercholesterolemia and some relative factors in Golestan province

GHR Veghari

Background and Aim: Cardiovascular disease is the first and for most factor for mortality in adults and hypercholesterolemia (HC) is a susceptible agent for them. The main objective of this study is to determine the of prevalence of HC and some risk factors related to it in adults in Golestan province in 2006.

Materials and Methods: This is a Crossectional-Descriptive study based on population and 1995 cases (997 men and 998 woman) between 25- 65 years old, were chosen by cluster and stratify sampling in Golestan adult population. We interviewed all the cases and determined anthropometric and biochemical indexes. Data was analyzed by SPSS.14 software. HC was defined as serum cholesterol levels over 200 mg/dl.

Results: Mean age was 39.2 year and mean ±SD of serum cholesterol in men and women was 196.7±39.11 and 209.4± 42.9 respectively. Prevalence of HC showed significant deference between men (44.7%) and women (57%) (P<0.05). There is a significant difference between age groups, region, physical activity and BMI in the mean value of serum cholesterol (P<0.01) but regarding economic status it is not significant. Prevalence of HC in abdominal obese and healthy group is 63.2% and 41% respectively and statistical difference is significant (P<0.05). The people of Golestan province consume fruits , vegetables and fish 4.84, 3.65 and 2 days in a week respectively and vegetable and fish are consumed more in HC group than in non- HC group. The consumption of hydrogenated oil, liquid oil and other type of oils is 85.4% ,14% and 0.7% respectively, and in HC people the intake of liquid oil is slightly higher than others, but statistical differences is not significant.

Conclusions: HC is one of the most health problems in Golestan province and women suffer from it more then men. Life style and food behavior are two risk factors for it. Thereby correction of food and social behavior can decline incidence of cardiovascular disease.

Isolation of enteroinvasive Escherichia coli (EIEC) from diarrhea in children by polymerase chain reaction (PCR) technique

MM Soltan Dallal

Background and Aim: Enteroinvasive Escherichia coli (EIEC) strains include a group of diarrheagenic Escherichia coli (DEC) and are known to cause shigellosis-like symptoms in both adults and children. They belong to a limited number of serotypes and their somatic (O) antigens are identical with, or related to, certain Shigella antigens. EIEC strains are confirmed by demonstration of invasiveness by polymerase chain reaction (PCR) for detection of the ipaH (invasive plasmid antigen H) gene that is specific for these strains among DEC.Since in our country,Iran study for detection of these strains. hasnot been carried out therefore the aim of this study was detection of EIEC in diarrheal under 5 year old children in Tehran.

Materials and Methods: During the descriptive study,300stool samples were collected from childrenwith diarrhea in Ali Asghar Hospital and children medicinal center of Tehran during 4 months (April-Jul 2008). E.coli species were isolated by standard bacteriological and biochemical tests. Presence of invasive plasmid antigen H (ipaH) gene in confirmed colonies was investigated by PCR technique.

Results: Among 300 stool specimens studied using culture method and biochemical tests,39(13%) E.coli species were isolated. Among these 39 strains,7(2.3%) strains containing ipaH gene (EIEC) were detected by PCR technique.

Conclusions: Enteroinvasive Escherichia coli (EIEC) in our country, Iran, may be as bacterial pathogen causing childhood diarrhea. Therefore we should apply new techniques for investigation of these strains.

Study of Implementation of Safety Regulations of Radiolog Departments in has petals of Tehran University of Medical Sciences

SMH Mousavi

Background and Aim: Because of preventing of radiation damages, special safety issues are considered in radiology departments: But, the other safety aspect issues are not observed regularly. As an important part of safety plan, radiology departments should be assessed from physical, building design aspects and cope with fire.

Materials and Methods: This descriptive study was directed as a cross sectional research. Tehran University of Medical Sciences hospitals radiology department were assessed for standards of physical spaces, radiation preventing, and cope with fire, patient's and staff safety.A Check-list was used as data collection instrument.Each safety issue estimated as safe (>80%), not safe (<50%) and relatively safe (between 50 and 80 %).

Results: Overall, safety standards were observed in Tehran university of Medical Sciences Hospitals Departments,with relatively safe standards regarding patient's safety and cope with fire.

Conclusions: Fire protocols must be regarded in radiology wards in hospitals. Appropriate designing and programming which considers patient's safety from the time of entering to radiology ward until leaving is offered.

The study of Nursing staff participation in strategic decision making in Tehran University of Medical Sciences Shariati Hospital

M Zahavi

Background and Aim: The main goal of each hospital - like all health care sectors - is protecting and increasing the health level in orsig country. The important role of human resources in hospitals is appropriate strategic decisions making for fast environmental changes and shows the need of staff participation. Nurses as a one of the biggest parts of hospital staff need to participate much more in strategic decision making in hospitals. This article is aimed to measure the level of nurses' participation in strategic decisions making.

Materials and Methods: This research is descriptive - analytic. Total nurses of Shariati hospital were 577 nurses of which 175 nurses were selected and studied.The gathering information instrument was questionnaire adapted from Dustdar thesis. This questionnaire contained 35,5 - choice questions set by Likert basis. Project's data was analyzed with SPSS software in % 95 confidence levels and statistical specifications like mean, standard error,correlation and non parametric tests were used.

Results: According to the results obtained, there are meaningful relation between staff participation in strategic decision making and: marriage situation (PV=0.01), Decision Directing (PV=0.0), culture of participation (PV=0.00), organization maturity (PV=0.00) and risk tolerance (PV=0.01)

Conclusions: It has been observed that nurse participation in strategic decision making in Shariati hospital is in "low" position (participation mean score: 28.52 from 100). So an administrator effort for spreading culture of participation to owner's process is something that should be paid attention more than before.

The comparison of two methods of vaginal discharge with and without speculum examination diagnosis of trichomonas infection

N Khodakarami

Background and Aim: Evaluation for STIs requires speculum examination. It is sometimes uncomfortable and rejected by many patients. Speculum examination often is impractical or not available in remote areas. Recently, it is possible to omit the speculum examination and noninvasively diagnose for Chlamydia and gonorrheal infections from urine sample. This comparison study was conducted by collected vaginal specimens directly without performing a speculum examination for the diagnosis of trichomonas infections.The aim of this study was comparison of two methods of vaginal discharge collection with and without speculum examination for diagnosis of the trichomonas infection.

Materials and Methods: We examined 100 patients with vaginal discharge to the gynecology clinic of the Taleghani hospital. Two vaginal swab were collected from vaginal discharge of patients before and during speculum examination for diagnosis of trichomoniasis. Both of vaginal specimens were tested with blinded microscopic. Compared collection methods sensitivities, specificity, positive predictive value, negative predictive value and accuracy of both methods was compared.

Results: Sensitivities, specificity, positive predictive value, negative predictive value and accuracy of speculum collection methods were 69%, 99%, 92% ,94% and 93% for trichomoniasis respectively. Sensitivities, specificity, positive predictive value, negative predictive value and accuracy of nonspeculum collection methods were 62.5%, 99%, 91%, 93% and 92% for trichomoniasis respectively. The differences between methods was not statistically significant (P= NS). There was a very good agreement between both methods for diagnosis of trichomoniasis (KAPPA= o.85).

Conclusions: We have demonstrated the benefit of nonspeculum vaginal specimens for the diagnosis of trichomoniasis. This technique has applicability for studies involving the epidemiology of vaginal infection as well as for home diagnostic testing ,elder and pregnant women respectively.

Comparative Study of Electronic Medical Education in Studied Countries

H Dargahi

Background and Aim: Electronic learning system is a new educational process which designed upon basis of computerized technology, multimedia and processors. It has several potentials and contexts.
To do comparative study and utilizing of successful electronic learning in developed countries could help us to develop this new process in Iran's Universities of Medical Sciences.

Materials and Methods: This research is developed descriptive comparative study in 2007 - 2008 by using of developed countries universities websites information and 62 references and keywords such as Electronic Educations,Medical Sciences Courses,Commutation Technology, Comparative Study and University in the field of electronic medical sciences. Then, the findings will compare with each developed countries universities and Iran's Universities of Medical Sciences.

Results: The results showed that Manchester and Dekin University have much experience in developing of electronic learning. The Students should be assessed by attendance, online and blended in developed universities.
Degree based courses are only present in South - Africa University, meanwhile single courses and training are present in other universities. Electronic health sciences courses and training are developed much more in compressive with others.

Discussion and Conclusion: The studied universities are different in history of construction, student assessment type, homework presence type, registration procedures, electronic medical education type with each other.
Iran's Universities of Medical Sciences, electronic education have several deficiencies in comparison with developed countries universities. We suggest appropriate technological and cultural infrastructure and use's skill improvement to develop this process in our country's universities of Medical sciences.

Prevalence and antibiotic susceptibility of isolated acinetobacters from blood culture in shariati hospital

y Erfani

Background and Aim: Acinetobacters are opportunistic pathogens and one of the important agents of nosocomial infections that causes many infections like septicemia and pneumonia. For resistance to antibiotics acinetobacters are mentioned as a healthcare system complications and are transmitted by the hands of healthcare workers. This research has performed in order to determine prevalence and antibiotic susceptibility of isolated acinetobacters from blood cultures.

Material and methods: This study was performed during a nine months period in shariati hospital. All 750 positive blood cultures were distinguished and prevalence of acinetobacter and antibiotic susceptibility of isolated acinetobacters were determined using disk diffusion agar method. Data were analyzed using SPSS software .

Results: According to our findings,133 blood cultures were positive for acinetoloacters(17.7% of cases). The most observed cases were isolated from emergency ward of hospital (65.5%). Antibiogram results using ciprofloxacin ,cotrimoxasol,gentamicin, ceftazidime, amikacine, tobramicine and ceftriaxone, showed maximum sensitivity to ciprofloxacine(91%) and cotrimoxazole (57.5%) and maximum resistance to ceftriaxone respectively.

Discussion and Conclusion: Because the most acinetobacter isolation was from emergency ward of hospital, it seems that a part of such infections is more due to contamination than real infection. Therefore it is recommended that a prospective cohort study considering standard and sterile conditions during sampling , by considering patients clinical features has to be performed.

A study of the top and middle managers knowledge and attitude on the feasibility of applying Total Quality Management in hospitals of Tehran University of Medical Science in 2009

S Safarani

Background and Aim: Managers today work in a dynamic environment. Their role in creating quality is essential. Today paying attention to the quality of goods and services is the first Paiority in heath care organizations which is in with contact peoples lives. Total Quality Management has undergone vast changes in health care management. The aim of this study is to determine the top (chief) and middle managers knowledge and attitude on the feasibility of applying Total Quality Management in hospitals of Tehran University of Medical Science in 2009.

Materials and Methods: This is a descriptive - analytic research. The study population consists of top and middle mangers of Tehran University of Medical Science in 2009. For data gathering , we have used a questionnaire which consisted of 46 questions. We assessed its validity by expert team and its reliability by subsample method (CI95%). Then the data were analyzed by SPSS software. The descriptive results(consist of mean, median, mode, std deviation, variance, range, maximum and minimum) and analytical results(consist of bivariate and Pearson tests) were obtained.

Results: The total mean of the top and middle managers knowledge for TQM is 73.24% and is in good range. The total mean of the top and middle managers attitude about TQM is 79.76% and is good and near to excellent range.There is a meaningful relation between top and middle managers knowledge and attitude for TQM. In total the coordination of the top and middle managers ideas for TQM is near to the each other and is good to applying it in hospitals.

Discussion and Conclusion: Total Quality Management is a new idea that is vital for organizations, especially for hospitals. Results of this survey show that top and middle managers knowledge and attitude are in good range but it needs promotion and continual teaching because when the knowledge and attitude change, the behavior of this managers also change and finally the behavior of all the employees in hospital will change. Also the goals of TQM that are the consent of the patients, employees and society and high quality of services will be acceptable and remain for promotion of good health in the society.

Attitude of Inpatients about Information Technologies

F Rangraz Jeddi

Background and Aim: Information Technologies (ITs) has become a significant resource for dissemination of information and resulted to an increase of health knowledge in communities. With attention to patient - centered approach this study was done to determine knowledge of inpatients about ITs.

Materials and Methods: A descriptive - cross-sectional study was done on 461 inpatient in Kashan University of Medical Sciences hospital's with a reliable (spearman Brown, r =0.83) and valid (face and content) questionnaire in two section, demographic information and study objects. Data gathering was done with interview then analyzed by SPSS and descriptive analysis.

Results: %42.1 and %26.7 of participants had knowledge about computer and the Internet relatively. %41.9 of them had the Internet access. 86.3% and 88.3% relatively would be interested to access and get medical records and their information. They intended to get test (%85.7), refill her/his prescription (79%), get appointment (%76.4), consult with physicians (%80), and get information about diets (80%) through ITs.

Discussion and Conclusion: It seems ITs attitude in inpatients is relatively good. Providing their information needs especially about prescription order and diets from CD or the Internet by hospital sites and introducing good medical sites to patient were recommended.

Comparison of apoptosis, circulating levels of tumor necrosis factor-α and tumor necrosis factor type-I receptor in Iranian patients with sepsis and normal controls

MM Amiri

Background and Aim: The present study was designed to compare the cell death, circulating levels of tumor necrosis factor-α and tumor necrosis factor type-I receptor in Iranian patients with sepsis and normal controls.

Materials and methods: Twenty-two patients with sepsis were included in this study. After blood collection, the serum circulating levels of TNF- and TNFRI measured with ELISA kits. The PBMCs isolated from blood samples and proportion of apoptotic cells measured by flowcytometry at the time of blood draws (0 time) and after 24-h incubation. PBMCs incubated at 37°C in culture (spontaneous apoptosis) and in the presence of rTNF that is capable of inducing apoptosis in activated T cells expressing the TNF family of receptors.

Results: PBMCs obtained from the patients showed significantly higher (P<0.001) proportion of apoptotic cells than PBMCs of controls at 0 time, indicated that a higher fraction of PBMCs were undergoing apoptosis in vivo in patients but not in controls. After 24-h incubation, spontaneous ex vivo apoptosis of PBMCs was nearly as high as that of TNF- induced apoptosis, indicating that activated T cells had been preprogrammed in vivo to die.

Discussion and Conclusion: The circulating levels of both TNF- and TNFRI showed significantly higher in patients (P<0.001) than controls and this increase is proportional (r=0.908) in both indicating that TNFRI may have a protective effect in the early stage of sepsis.