Medical Journal of the Islamic Republic of Iran最新文献

Background: Managerialism and leaderism were introduced in response to the challenges in public service management, aiming to improve the management of public service organizations. These ap-proaches both have their own strengths and challenges. The purpose of this study was to examine the current and desired state of the Iranian health system and to find whether these approaches can be integrated to leverage their strengths and address some of the management and leadership challenges of the country's health system.

Methods: In this qualitative study, semi-structured interviews were conducted with 43 senior managers of the health system, employees of three medical universities in Tehran, and experts in public management. The participants were selected using purposive sampling, and the snowball technique was used to increase the number of interviewees. The data were analyzed using the framework method in MAXQDA 18.

Results: Structural changes, realization of managerialism, establishment of evidence-based in-formation systems, readiness of managers and employees, creating a climate of trust, identifica-tion, and recruitment of competent individuals, specialized training, delegation of sufficient au-thority to managers, building a culture conducive to an integrated approach, communication and cooperation, and benchmarking were identified as the prerequisites for complementing Manageri-alism Ideology with Leaderism Discourse.

Conclusion: Complementing managerialism ideology with leaderism discourse can help solve some of the management and leadership challenges faced by the country's health system. But more important are the prerequisites that need to be satisfied in order to prepare the ground for integrating these approaches and capitalizing on their advantages.

Background: Pectus excavatum is the most frequent congenital defect of the chest wall. Surgical treatment with modified Ravitch-type repair is recommended in patients with cosmetic dissatisfaction or considerable cardiopulmonary symptoms. We aimed to analyze the surgical, aesthetic, cardiopulmonary functions and patient satisfaction outcomes of modified Ravitch repair pre and postoperatively.

Methods: This was a prospective analysis of 13 pectus excavatum patients undergoing repair by modified Ravitch using a permanent titanium plate fixed with a screw from September 2021 to August 2023. Patients were included to relieve pressure on the heart and lungs if complaining of exercise intolerance, cosmetic impairment, shortness of breathing, chest pain, or psychological disturbance with an age range from 10 years to 30 years old. While patients who had received conservative or surgical treatment previously or patients with scoliosis, Marfan syndrome or bronchial asthma were excluded. At the 6-month postoperative visit, a postoperative satisfaction survey was conducted.

Results: The means of the age of patients (16.4 ± 2.36 years); operative duration (120 minutes); blood loss (200± 15.47 mL) and Haller index was (3.8± 0.35) preoperatively compared with less than 3.0 (2.7± 0.08 postoperatively; hospital stay (7 days). The most frequent complications were seroma in one patient (7.69%), postoperative bleeding in one patient (7.69%) and skin infection in one patient (7.69%) of patients. No recorded infection of the sternal plate or required operative re-exploration for infection. All patients were subjectively satisfied with the excellent surgical results. Exercise intolerance despite increased exercise performance was observed following surgery, including less sensation of dyspnea.

Conclusion: Modified Ravitch-type repair is a secure and reliable method for treating pectus excavatum with better relief of preoperative symptoms.

Background: Individuals who have undergone lower limb amputation often struggle with excessive heat and sweating in their prosthetic sockets. This is due to the closed environment of the socket, which disrupts the body's natural cooling mechanisms and can lead to increased skin temperature, sweating, and various skin problems. This study aimed to develop a new socket to alleviate heat buildup in those with below-knee amputation.

Methods: A positive residual limb model of a below-knee amputee was used to create a new socket made of copper metal through electroforming. A cooling system was programmed so that if the temperature exceeded a predetermined threshold, the system would be activated to prevent further temperature increase. The participant wore the conventional and new socket with the cooling system, and his residual limb skin temperature was monitored using a temperature data logger.

Results: Implementing the new socket led to a significant 5°C to 6°C reduction in temperature within the socket, greatly enhancing thermal comfort and reducing heat sensation for the users.

Conclusion: By incorporating the new socket and cooling system, substantial reductions in heat accumulation within the prosthetic socket can be achieved.

Background: To reduce the clinical burden of COVID-19, healthcare providers, and policymakers need a clear understanding of the illness severity during epidemic waves. This study aimed to identify the clinical severity of patients with COVID-19 during different stages of an epidemic wave (pre-peak, peak, post-peak) in four provinces in Iran.

Methods: We conducted a secondary analysis of the data on COVID-19 patients admitted to hospitals (25,382 cases), which were recorded in the Medical Care Monitoring Center. Data included adult patients (≥18 years) who were hospitalized due to COVID-19 infection, confirmed by a positive SARS-CoV-2 RT-PCR test. No exclusion criteria were applied. A pairwise comparison method was used to evaluate clinical severity. Then, based on univariable and multivariable linear regression models, the severity scores of patients were compared during various stages of an epidemic wave.

Results: The findings showed that the level of severity of the disease was higher during and after the peak in the total population. The means (SD) of severity scores were 0.16 (0.25), 0.18 (0.26), and 0.19 (0.26) before, during and after the peak, respectively. Besides, age and the underlying disease had a positive and significant relationship with disease severity.

Conclusion: During the middle and late phases of the COVID-19 epidemic wave, hospitals are seeing patients with more severe illnesses than in the early stages. Enhancing hospital preparedness is essential to avert excess deaths and critical cases. Moreover, it is important to maintain ongoing monitoring of clinical symptoms during the recovery phase to support individual patients, guide public health policy, and enhance scientific understanding of epidemic recovery processes.

Background: Cancer is one of the diseases affecting the elderly and can lead to loss of life years. The skin, breast, gastric, colorectal, and lung cancers are five prevalent cancers in the elderly. The present study was conducted to evaluate the incidence and burden of these cancers in the elderly.

Methods: This secondary study was conducted on available extracted data from the population-based cancer registry in Markazi province in 2019. The data of all cases older than 60 years that lived more than six months in Markazi province were extracted. Collecting information involves gathering data on cancer incidence and death rates based on age and sex groups, as well as overall mortality rates. This also includes survival rates, recovery rates for cancer patients, and disability attributed to cancer using the global burden of disease (GBD) standard table from various sources. Various data, including the latest death registration report and the latest cancer registration report for 2019 and the Iran Statistics Center, were obtained. In order to check and analyze the data, Excel and DISMOD2 software were used. In order to analyze the data, formulas for calculating the burden of diseases (DALY=YLL+YLD) were used. For the validity and reliability of the data, the method of preventing the registration of impossible codes and useless codes was used.

Results: The incidence rate of skin, breast, gastric, colorectal, and lung cancers in elderly women was 52.87, 59.02, 67.63, 47.95, and 20.90, respectively, per 100000. DALYs of these cancers in elderly women were 63.15, 423.86, 686.37, 366.49, and 385.18, respectively. The incidence rate of skin, gastric, colorectal, and lung cancers in elderly men was 100.84, 135.80, 49.74, and 68.57, respectively per 100000. DALYs of these cancers in elderly men were 342.31, 1117.01, 337.99, and 452.41, respectively. The highest YLL and YLD were related to gastric cancer (493.31/100,000) and breast cancer (220.84/100,000).

Conclusion: Based on the results of this study, the incidence, mortality, and DALY of skin, breast, stomach, colorectal and lung cancers were higher in the elderly. In this study, the burden of some cancers such as breast, was lower compared to provinces such as Yazd.

Background: In Iran, one of the most important and influential sources for financing the Primary Health Care (PHC )is the government budget. This study was conducted with the aim of evaluating the allocation of the PHC budget and evaluating the equality in the allocation of these resources.

Methods: In this applied descriptive-analytical study, the study population included all of Iran's 31 provinces. Data was gathered from the registered statistics of the Ministry of Health and the Iranian Statistics Center for the years 2021 and 2022. In this research, the Gini coefficient and the Lorenz curve have been used to measure equality in the allocation of the PHC budget.

Results: The results showed that in 2022, the PHC budget increased by 50% compared to 2021. 20 provinces received less than the national average, and 11 provinces received more than the national average. The average allocation budget in urban areas in 2021 and 2022 is 596,452 and 854,936 million rials ($2,385,808 and $2,374,822), respectively. The average allocation budget in rural areas in 2021 and 2022 is 1,144,350 and 1,752,936 million rials, respectively ($4,577,400 and $4,869,267). The numerical value of the Gini coefficient for the budget allocation in 2021 and 2022 was 0.20 and 0.19, respectively.

Conclusion: The Gini coefficient shows that the allocation of the PHC budget is relatively unequal. Advocacy for the reallocation of resources in the health sector based on evidence and based on the deprivation coefficient of demographic groups is one of the most basic ways to support the more deprived and less developed provinces.

Background: Millions of people worldwide suffer from back pain and muscle weakness due to adolescent idiopathic scoliosis (AIS). It has been found that Schroth exercises (SE) are the most effective treatment for AIS. However, it is still not clear how combining SE with asymmetric spinal stabilization exercises (ASSE) can impact back pain and trunk extensor muscle endurance (TE). This study aims to compare the effects of SE with and without ASSE on back pain and TE in AIS.

Methods: A randomized controlled trial was conducted with 40 boys aged 10 to 18 years who had AIS. They were divided into three groups: SE+ASSE (n = 15), SE only (n = 15), and a waitlist control (n = 10). The participants underwent exercise training for 50-70 minutes three times a week for up to 12 weeks. The study evaluated two variables, namely, back pain (measured with a Visual Analog Scale or VAS) and TE (measured with the Biering-Sorensen test), before and after the interventions. For statistical analysis, a post-hoc Bonferroni test following analysis of covariance (ANCOVA) was used at α = 0.05.

Results: According to a study, patients who underwent a combination of SE and ASSE experienced a significant reduction in back pain (VAS score = 2.9±0.8 to 0.1±0.4) as compared to those who only underwent SE (VAS = 2.7±0.9 to 1.5±1.2) and the control group. No significant difference was found between the SE group and the control group in terms of back pain reduction. Furthermore, there was no significant difference in TE among the three groups. However, the combined exercises showed a numerical improvement (75.6±52.5 sec to 119.2±62.6 sec) compared to the other groups (P = 0.311).

Conclusion: The combination of SE and ASSE is more effective in reducing back pain in AIS than SE alone or control. Although there was no significant difference between the three groups in terms of improving the TE, the SE and ASSE groups showed better results numerically.

Background: High titers of specific antibodies to cyclic citrulline peptide (ACCP) are often present in the serum of patients with rheumatoid arthritis (RA) and, together with rheumatoid factor (RF), are a diagnostic marker of RA. Brucellosis is a zoonotic infection in which osteoarticular involvement occurs in 10-85% of patients. RF in brucellosis patients is significantly higher than in healthy people.

Methods: We presented 2 cases of brucellosis spondylodiscitis with positive results for RF and ACCP, which aroused great interest among the rheumatologists of our center.

Results: Both patients described were men (27 and 60 years old) with arthritis, back pain, and high levels of rheumatoid arthritis-specific antibodies. These patients were suspected of having tuberculous spondylitis, but the tuberculous process was excluded using specific tests. During antibacterial therapy, there is a dynamic decrease in antirheumatoid antibodies. X-rays of the hand joints revealed no signs of erosive arthritis.

Conclusion: All cases of arthritis, spondylitis, and spondylodiscitis in endemic areas require careful analysis and comparison of patients' clinical and laboratory-instrumental data to prevent misdiagnosis. With brucellosis infection, against the background of adequate antibacterial therapy, inflammation of the joints and spine is reversible.

Background: The anatomy of the eyelid changes with age. Multiple changes were observed in the eyelids and the surrounding structures including the malar region. Aging affects the appearance of eyelids and midface by the formation of tear trough deformity and malar flattening and ptosis. To define the effect of malar fat suspension on the lateral part of the infraorbital wall and orbital fat transposition in tear-trough and malar flattening and ptosis.

Methods: A retrospective study was carried out on 15 patients who had surgeries between January 2020 and January 2022. This technique combines orbital fat transposition to the medial side of the infraorbital wall and malar fat suspension to the lateral side of the infraorbital wall. The average follow-up period was 12 months. Values were compared by paired samples student or Wilcoxon signed rank test for quantitative and qualitative data respectively.

Results: There was a significant improvement in tear trough deformity, malar ptosis, and midface lift (P < 0.5). No recurrence was observed on follow-up of 12 months. One patient experienced minor postoperative complications in the form of prolonged ecchymosis for 2 months.

Conclusion: The transcutaneous lower blepharoplasty with orbital fat transposition and malar fat suspension to the lateral part of the infraorbital wall can be considered a safe and effective intervention with improved aesthetic outcome. Thus, it is recommended in patients with tear trough deformity and malar ptosis.

Background: Behavioral problems in children contribute significantly to non-compliance and lack of cooperation with dentists.This study aimed to assess the impact of parenting styles on the success of conscious sedation with midazolam in uncooperative children aged 4 to 6 years.

Methods: This short-term longitudinal study included ninety-six children aged 4-6 years who were classified as uncooperative according to the Frankl Behavior Rating Scale (Frankl I, II), requiring pulp treatment and Stainless-Steel Crown (SSC) restoration. Midazolam was orally administered at 0.25 mg/kg. Parenting Styles and Dimensions Questionnaire (PSDQ), Strengths and Difficulties Questionnaire (SDQ), and Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Treatment began at least thirty minutes post-drug administration. Vital signs were monitored using a pulse oximeter. Sedation effectiveness was assessed with the Houpt scale at local anesthesia injection (T0), cavity preparation (T1), restoration (T2), and treatment conclusion (T3). Statistical analysis used Mann-Whitney U test (P < 0.05).

Results: Most parents (69, 71.9%) had an authoritative parenting style, while 10 (10.4%) were authoritarian, and 17 (17.7%) were permissive. Authoritative parenting is associated significantly with sedation success (P = 0.001) and reduced dental fear (P = 0.008). Conversely, authoritarian (P = 0.031) and permissive (P = 0.001) parenting styles are associated with sedation failure. Authoritarian parenting is associated positively with increased dental fear (P = 0.001). No significant association was found between permissive parenting style and dental fear (P > 0.05). No significant association existed between behavioral problems and parenting styles (P > 0.05). There was no significant association observed between permissive parenting style and dental fear (P = 0.279). Similarly, no significant associations were found between behavioral problems and specific parenting styles: authoritative (P = 0.625), authoritarian (P = 0.050), and permissive (P = 0.522).

Conclusion: Understanding parenting styles aids in predicting conscious sedation success with midazolam and assisting in managing uncooperative children during dental procedures.