Iranian Red Crescent Medical Journal最新文献

Background: The introduction of fluids to infants during the first days postpartum, which may be harmful to infant health, is a common practice in Iran.

Objectives: This study aimed to find the prevalence of breastfeeding practices using monthly dietary recall and factors associated with introduction of fluids during the first month of life and determine the effects of these supplementations on breastfeeding survival.

Patients and methods: This longitudinal study carried out in Shahroud, Iran from May 2011 to October 2013. Using convenient sampling strategy, 358 mothers in their third trimester of pregnancy were enrolled in the study and completed the questionnaires. Then the data regarding the introduction of fluids during first month postpartum was collected. We followed women monthly up to breastfeeding cessation. Kaplan-Meier and time-to-event methods were used to assess breastfeeding survival. A multinomial logistic regression analysis was used to identify the variables that determined breastfeeding practices at the first month postpartum. The Cox regression analysis was used to estimate the effect of variables on breastfeeding survival.

Results: The prevalence of exclusive, predominant, and partial breastfeeding during the first month postpartum were 33.1%, 58.2%, and 8.6%, respectively. Predominant breastfeeding was associated with the lack of breastfeeding experience (OR = 1.93; 95% CI [1.02 - 3.66]). Partial breastfeeding was associated with the maternal age ≥ 30 y (OR = 5.96; CI [1.66 - 21.37]), family income higher than the mean (OR = 3.39; 95% CI [1.17 - 9.81]), and breastfeeding difficulties score higher than mean (OR = 3.09; 95% CI [1.10 - 8.71]). The Cox regression analysis revealed that breastfeeding practices at the first month was associated with an increased risk for breastfeeding discontinuation. The hazard ratio of breastfeeding discontinuation for predominant and partial breastfeeding groups were 1.11 (95% CI: 0.82, 1.51; P = 0.49) and 2.23 (95% CI: 1.39, 3.58; P = 0.001), respectively compared to the exclusive group.

Conclusions: The prevalence of predominant breastfeeding during the first month postpartum is high in Shahroud. Interventions to strengthen adherence to WHO guidelines for breastfeeding should be considered. Breastfeeding education providers at the hospitals should emphasize the effects of formula on breastfeeding continuation at early postpartum.

Background: Acute cholecystitis is the most common complication of gallbladder stones. Today, Tokyo guidelines criteria are recommended for diagnosis, grading, and management of acute cholecystitis.

Objectives: We aimed to evaluate the levels of C-reactive protein (CRP) at different cut-off values to predict the severity of the disease and its possible role in grading the disease with regard to the guideline.

Patients and methods: This is a retrospective study, analyzing 682 cases out of consecutive 892 patients with acute cholecystitis admitted to two different general surgery clinics in Istanbul, Turkey. Records of patients diagnosed with acute cholecystitis were screened retrospectively from the hospital computer database between January 2011 and July 2014. A total of 210 patients with concomitant diseases causing high CRP levels were excluded from the study. The criteria of Tokyo guidelines were used in grading the severity of acute cholecystitis, and patients were divided into 3 groups. CRP values at the time of admission were analyzed and compared among the groups.

Results: Mean CRP levels of groups were found to be significantly different, 18.96 mg/L in Group I, 133.51 mg/L in Group II, and 237.23 mg/L in Group III (P < 0.001). Having examined CRP values among the groups, they were found to be highly and significantly correlated with the disease grade (P < 0.0001). After evaluating CRP levels according to the grade of the disease, group 2 was distinguished from group 1 with a cut-off CRP level of 70.65 mg/L, and from group 3 with a value of 198.95 mg/L. Those results were found to be statistically significant (P < 0.001).

Conclusions: CRP, a well-known acute phase reactant that increases rapidly in various inflammatory processes, can be accepted as a strong predictor in classifying different grades of the disease, and treatment can be reliably planned according to this classification.

Background: Despite effective diagnosis and treatment, prevalence of tuberculosis (TB) is still growing. The directly observed treatment, short-course (DOTS) strategy to treat TB was introduced by the World Health Organization more than a decade ago. Little is known about patients' experience of TB treatment, according to DOTS, in Iran.

Objectives: This study aimed to understand the patients' experience of tuberculosis treatment according to DOTS in Iran.

Patients and methods: This study is a qualitative study, using content analysis to examine patients' experience of TB treatment and to understand their compliance during DOTS. In this study, a semi-structured interview with open questions was answered by 40 patients, who had a diagnosis of pulmonary and extrapulmonary tuberculosis, and improved during the course of their treatment. The method of sampling was purposive sample and the interview process lasted until data saturation.

Results: Data analysis resulted in the extraction of six themes, which reflect the experiences of the study participants. The themes are: 1) individual factors; 2) change of the attitudes and beliefs of patients on TB treatment; 3) support terms of patients with tuberculosis; 4) the role of health care professionals; 5) social factors and 6) the financial burden.

Conclusions: Successful completion of TB treatment requires an effective partnership between the patient and health care professionals, and a harmony between the cultural context, attitude of the patient, family support and health literacy. Future health policies should address these issues to improve patients' adherence to DOTS.

Background: Aerial firing is shooting, using fire arm, into the air usually during a celebration.

Objectives: This observational study aimed to quantify magnitude and impact of stray bullet injuries by aerial firing at surgical emergencies of the Liaquat University Hospital (a university hospital), Hyderabad, Sindh, Pakistan from January 2009 to December 2010 (2 years).

Patients and methods: During the study period, 144 firearm injuries due to stray bullet reported to the A and E departments of the university hospital. All patients referred to surgical unit providing emergency cover on that day irrespective of the severity of the injury for medico-legal reasons. For this study, the cases were divided into those having trivial injury and do not require any active surgical intervention and those having serious injury mandating surgical intervention. One hundred and two cases of stray bullet injury sustained trivial injury and followed as outpatients after an overnight period of indoor hospitalization; however, 42 patients with stray bullet injuries requiring surgical intervention were hospitalized.

Results: The most common events leading to aerial firing and stray bullet injuries were marriage ceremonies, followed by a political rallies and New Year celebrations. Stray bullet injury also reported after aerial firing on cricket/hockey team victories, Pakistan Independence Day (14th August), cultural day in Sindh and Basant (Kite) festival in Punjab. The most frequent sites with serious stray bullet injury were chest (15), head and neck (10), abdomen (9) and limbs (8), respectively. Surgical interventions performed included chest intubation, exploration of wound tract to retrieve bullet if lodged superficially and was palpable, laparotomy to managed intra-abdominal injury, reduction of fracture site followed by reconstruction, flap reconstruction and graft for nonhealing wound. The mean duration of hospital stay was 19 days. No mortality was observed in this series of patients.

Conclusions: We conclude that the prevalence of aerial firing resulting in stray bullet injuries is alarmingly on rise in our country. Above all, those doing aerial firing do not considered it as crime, instead taken it as they are privileged to do anything when celebrating. Awareness of the consequences must be propagated by every means to condemn this social crime.

Background: Still there is no consensus on the best treatment for abdominal pain-related functional Gastrointestinal Disorders (FGIDs).

Objectives: The purpose of this study was to compare the effects of a synbiotic Lactol (Bacillus coagulans + fructooligosaccharide (FOS)), peppermint oil (Colpermin) and placebo (folic acid) on abdominal pain-related FGIDs except for abdominal migraine.

Patients and methods: This placebo-controlled study was conducted on 120 children aged 4 - 13 years to compare the efficacy of pH-dependent peppermint oil (Colpermin) versus synbiotic Lactol (Bacillus coagulans + fructooligosaccharids (FOS)) in decreasing duration, severity and frequency of functional abdominal pain. The patients were randomly allocated into three equal groups (n = 40 in each group) and each group received Colpermin or Lactol or placebo.

Results: Eighty-eight out of 120 enrolled patients completed a one-month protocol and analyses were performed on 88 patients' data. Analyses showed that improvement in pain duration, frequency and severity in the Colpermin group was better than the placebo group (P = 0.0001, P = 0.0001 and P = 0.001, respectively). Moreover, pain duration and frequency were decreased in the Lactol group more than the placebo (P = 0.012 and P = 0.0001, respectively), but changes in pain severity were not significant (P = 0.373). Colpermin was superior to Lactol in decreasing pain duration and severity (P = 0.040 and P = 0.013, respectively). No known side effects or intolerance were seen with Colpermin or Lactol.

Conclusions: The pH-dependent peppermint oil capsule and Lactol tablet (Bacillus coagulans+ FOS) as synbiotics seem to be superior to placebo in decreasing the severity, duration and frequency of pain in abdominal pain-related functional GI disorders.

Background: There is no legal requirement for Iranian military truck drivers to undergo regular visual checkups as compared to commercial truck drivers.

Objectives: This study aimed to evaluate the impact of drivers' visual checkups by comparing the visual function of Iranian military and commercial truck drivers.

Patients and methods: In this comparative cross-sectional study, two hundred military and 200 commercial truck drivers were recruited and their Visual Acuity (VA), Visual Field (VF), color vision and Contrast Sensitivity (CS) were assessed and compared using the Snellen chart, confrontation screening method, D15 test and Pelli-Robson letter chart, respectively. A questionnaire regarding driving exposure and history of motor-vehicle crashes (MVCs) was also filled by drivers. Results were analyzed using an independent samples t-test, one-way ANOVA (assessing difference in number of MVCs across different age groups), chi-square test and Pearson correlation at statistical significance level of P < 0.05.

Results: Mean age was 41.6 ± 9.2 for the military truck drivers and 43.4 ± 10.9 for commercial truck drivers (P > 0.05). No significant difference between military and commercial drivers was found in terms of driving experience, number of MVCs, binocular VA, frequency of color vision defects and CS scores. In contrast, the last ocular examination was significantly earlier in military drivers than commercial drivers (P < 0.001). In addition, 4% of military drivers did not meet the national standards to drive as opposed to 2% of commercial drivers. There was a significant but weak correlation between binocular VA and age (r = 0.175, P < 0.001). However, CS showed a significantly moderate correlation with age (r = -0.488, P < 0.001).

Conclusions: The absence of legal requirement for regular eye examination in military drivers caused the incompetent drivers to be missed in contrast to commercial drivers. The need for scientific revision of VA standard for Iranian drivers is also discussed. The CS measurement in visual checkups of older drivers deserves to be investigated more thoroughly.

Background: Despite the significant contribution of cultural factors to sexual satisfaction, most of the current sexual satisfaction scales pay little attention, if any, to cultural factors and marital status.

Objectives: The current study aimed to develop and validate the Married Women's Sexual Satisfaction Scale.

Patients and methods: The current methodological study went through three consecutive phases. In the first phase, the concept of sexual satisfaction was defined and analyzed by the hybrid model approach. In the second phase, an item pool was generated by the findings of the first phase. Finally, the psychometric properties of the scale were evaluated in the third phase. All data analyses were performed by the SPSS version 19.0.

Results: A 78-item pool was generated based on the findings of the concept analysis phase. After assessing and confirming its face and content validity, 27 items remained in the final version of the scale. The exploratory factor analysis revealed a four-factor structure for the scale. The results of the known-groups comparison showed that females with lower educational status had significantly lower sexual satisfaction. Moreover, there was a significant correlation between the scores of the finalized scale and those of the ENRICH Marital Satisfaction Scale (r = 0.706, P = 0.01). The interclass correlation between the test and the retest measurements was also statistically significant (ICC = 0.939, P value = 0.001).

Conclusions: The 27-item Iranian Married Women's Sexual Satisfaction Scale is a simple, valid, and reliable tool to assess married women's sexual satisfaction.

Background: Tuberculosis (TB) is a major global health problem, which has been ranked as the second leading cause of death from an infectious disease worldwide. Diagnosis based on cultured specimens is the reference standard, however results take weeks to process. Scientists are looking for early detection strategies, which remain the cornerstone of tuberculosis control. Consequently there is a need to develop an expert system that helps medical professionals to accurately and quickly diagnose the disease. Artificial Immune Recognition System (AIRS) has been used successfully for diagnosing various diseases. However, little effort has been undertaken to improve its classification accuracy.

Objectives: In order to increase the classification accuracy of AIRS, this study introduces a new hybrid system that incorporates a support vector machine into AIRS for diagnosing tuberculosis.

Patients and methods: Patient epacris reports obtained from the Pasteur laboratory of Iran were used as the benchmark data set, with the sample size of 175 (114 positive samples for TB and 60 samples in the negative group). The strategy of this study was to ensure representativeness, thus it was important to have an adequate number of instances for both TB and non-TB cases. The classification performance was measured through 10-fold cross-validation, Root Mean Squared Error (RMSE), sensitivity and specificity, Youden's Index, and Area Under the Curve (AUC). Statistical analysis was done using the Waikato Environment for Knowledge Analysis (WEKA), a machine learning program for windows.

Results: With an accuracy of 100%, sensitivity of 100%, specificity of 100%, Youden's Index of 1, Area Under the Curve of 1, and RMSE of 0, the proposed method was able to successfully classify tuberculosis patients.

Conclusions: There have been many researches that aimed at diagnosing tuberculosis faster and more accurately. Our results described a model for diagnosing tuberculosis with 100% sensitivity and 100% specificity. This model can be used as an additional tool for experts in medicine to diagnose TBC more accurately and quickly.

Background: Gossypiboma is the term for forgotten textile products such as a surgical sponge and compress in the body cavity after a surgical procedure.

Objectives: The aim of this study was to evaluate previously published articles related to post cholecystectomy gossypiboma.

Materials and methods: We conducted a systematic search using PubMed, Medline, Google and Google Scholar on post cholecystectomy gossypiboma. The keywords used were: gossypiboma and cholecystectomy, textiloma and cholecystectomy and post cholecystectomy gossypiboma. Furthermore, we also present a new case of post cholecystectomy gossypiboma.

Results: A total of 32 articles concerning 38 patients with post cholecystectomy gossypiboma that met the aforementioned criteria were included. Detailed intraoperative findings and surgical management were provided. The patients were aged from 26 to 79 years (Mean ± SD: 47 ± 13.6 years); 32 were female and six were male. The time from the causative operation to presentation with a retained surgical sponge ranged from one to 480 months (Mean ± SD: 56.5 ± 93.5 months).

Conclusions: Gossypiboma may not be symptomatic for many years or could be symptomatic for a short duration of time. Besides being a rare surgical complication, gossypiboma can lead to serious morbidity and mortality that may cause medico-legal problems. Diagnosis with imaging methods is difficult.

Background: Iron-loaded cardiac complication is the essential cause of mortality in patients with thalassemia. Early detection and treatment of cardiac over-load can reduce mortality.

Objectives: The current study aimed to evaluate the relationship between serum ferritin levels and T2* magnetic resonance imaging (MRI) of heart and liver and liver iron concentration (LIC) to diagnose iron over load in countries with limited access.

Patients and methods: In the current cross-sectional study, 85 Iranian patients with thalassemia with the mean age of 22.7 ± 7 years were randomly selected. All patients were on regular blood transfusion. Echocardiography of heart and liver T2* MRI, determination of serum ferritin levels, and LIC were performed in all subjects at the same time. The correlation of serum ferritin levels with T2*MRI of heart and liver, and LIC was assessed. P value < 0.05 was considered statistically significant.

Results: Abnormal myocardial iron load (T2* MRI < 20 ms) was detected in 58% of the patients and among whom, 36% had severe myocardial iron load (T2* MRI < 10 ms). Median and interquartile range of serum ferritin levels were 1434 and 2702 respectively in patients with thalassemia. Serum ferritin levels showed a statistically significant positive correlation with LIC (rs = 0.718, P < 0.001) and significant negative correlation with T2* Heart (rs = -0.329, P = 0.002), and T2* Liver (rs = -0.698, P < 0.001). However, Ejection fraction was not significantly correlated with serum ferritin levels in the patients (P = 0.399).

Conclusions: Serum ferritin levels can be used to diagnose iron over-load in patients with thalassemiaas an alternative method in areas where T2* MRI is not available.