Publications by authors named "Abtin Heidarzadeh"

43 Publications

Seroprevalence of SARS-CoV-2 in Guilan Province, Iran, April 2020.

Emerg Infect Dis 2021 02 21;27(2):636-638. Epub 2020 Dec 21.

We determined the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in an affected area in northern Iran in April 2020. Antibodies to SARS-CoV-2 were detected in 528 persons by using rapid tests. Adjusted prevalence of SARS-CoV-2 seropositivity was 22.2% (95% CI 16.4%-28.5%).
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http://dx.doi.org/10.3201/eid2702.201960DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853569PMC
February 2021

Intraperitoneal Instillation of Lidocaine for Postoperative Pain Relief after Total Abdominal Hysterectomy: A Double Blinded Randomized Placebo-controlled Trial.

Iran J Pharm Res 2020 ;19(2):317-322

Reproductive Health Research Center, Department of Obstetrics and Gynecology, Alzahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Pain after total abdominal hysterectomy (TAH) is a major concern. Pain management is very important issue after TAH. This study aimed to assess the efficacy of intraperitoneal instillation of lidocaine for postoperative pain relief after TAH. A double-blinded randomized placebo-controlled trial was conducted on patients undergoing total abdominal hysterectomy in Al-zahra hospital from June 2007 to July 2008. Forty patients were randomly assigned with equal number in two lidicaine (N = 20) and normal saline (N = 20) groups. The lidocaine group received 50 mL of 0.8% lidocaine with epinephrine and placebo group received 50 ml of saline 0.9%. We used 10 cm visual analog scale (VAS) for assessing pain at 8, 12, and 24 h at rest and 48 h on movement. Opioid consumption, patient' satisfaction with pain control, and incidence of postoperative nausea and vomiting were assessed. Means of pain score at different times in lidocaine group were significantly lower than placebo group ( ˂ 0.05) the difference between mean dose of opioid consumption over 24 h between two groups was not significant ( = 0.785). Patient's satisfaction score in lidocaine group was significantly higher than saline group = 0.034). Differences in incidence of postoperative nausea and vomiting between two groups were not significant ( = 1.0). Intraperitoneal instillation of 50 mL of 0.8% lidocaine with epinephrine is an effective and safe technique for postoperative pain management after TAH. But this technique cannot reduce opioid consumption over 24 h after TAH.
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http://dx.doi.org/10.22037/ijpr.2020.1101084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667566PMC
January 2020

Strengths and Weaknesses of Family Physician MPH Course in Iran: The Viewpoints of Managers and Physicians.

Int J Prev Med 2020 10;11:150. Epub 2020 Sep 10.

Department of Community Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Background: Since 2009, the MPH course has been implemented in Iran. After eight years, this study aimed to evaluate family physician MPH program in Iran.

Methods: This cross-sectional study was conducted on 255 graduates of family physician MPH, selected through simple random sampling and 95 managers who were involved in the design and implementation of the course in 13 universities, selected by census method, in 2017. Data collection tools were two researcher-made questionnaires, delivered to the subjects through emails. Data analysis was performed in SPSS version 21 using central and dispersion indices, Chi-square, and independent -test.

Results: Approximately half of the participants considered the course length as appropriate, 14.5% of them considered the duration of the course short, and 28.9% of them considered it long and there was no significant difference between the views of managers and physicians in this regard. On the other hand, there was a significant difference between managers and physicians regarding the variables of cost-effectiveness, motivation to participate in the course, the necessity of presenting the thesis, applicability of the content, comprehensibility of the content of the course, and desirability of the course load. Thus, a higher percentage of managers acknowledged the necessity of theses and duties as well as the applicability of the content, and a higher percentage of physicians referred to cost-effectiveness and the motivation to participate in the course.

Conclusions: According to the results of the study, the participants have proposed some strategies, such as revising the educational content, clarifying the future position of the trained physicians and granting privileges, specifying the program goals, being accurate in selecting motivated applicants with an interest in this field in order to improve the quality of educational courses.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_165_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643570PMC
September 2020

Management of COVID-19 Crisis in Guilan Province in Northern Iran.

Arch Iran Med 2020 07 1;23(7):511-513. Epub 2020 Jul 1.

Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

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http://dx.doi.org/10.34172/aim.2020.52DOI Listing
July 2020

Persian version of Patient-Reported Outcome Measure for Urethral Stricture Surgery (USS-PROM) Questionnaire, Validation and Adaptation Study.

Urol J 2020 01 26;17(1):61-67. Epub 2020 Jan 26.

Infertility and Reproductive Health Research Center Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: The aim of the present study was translation, cross cultural adaptation and face validity evaluation of the Persian version of Patient-Reported Outcome Measure for Urethral Stricture Surgery (USS-PROM) Questionnaire.

Materials And Methods: This study was assessed: translation, translation quality, reverse translation and comparison of the english version, Content validity, internal consistency and stability. Content validity presents by index of content validity (CVI) and the content validity ratio (CVR). Internal consistency reliability was tested by Cronbach's ?, and test-retest reliability was evaluated by Intraclass Correlation Coefficient (ICC) assessed by Guttman two way mixed absolute agreements.

Result: Frothy males with history urethroplasty and mean age of 41.4±9.08 (range of 19 to 52) years old; enrolled.  In the case of mean scores of difficulty from the 16 translated items, 80% had easy translation. In terms of translation quality, 92% were the satisfactorily clear. In terms of similar concept, 92% were satisfactory. The overall quality of the translation was satisfactory at 88%. The translated questionnaire has a good internal consistency (Cronbach's alpha as 0.84). CVI and the CVR, test-retest ICC evaluation were appropriate/acceptable in all questions. The questionnaire ICC was .791(CI 95%, .678-.876). Two main different aspects of the questionnaire consisted of urinary symptoms (question 1-10) and Quality of life (question 11-15) Cronbach's alpha were .800 and .671 respectively.

Conclusion: The Persian version of the questionnaire has acceptable cultural adaptation and face Validity. Further studies should be done using this translated tool to determine its applicability in the urethroplasty patients.
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http://dx.doi.org/10.22037/uj.v0i0.4937DOI Listing
January 2020

The PERSIAN Guilan Cohort Study (PGCS).

Arch Iran Med 2019 01 1;22(1):39-45. Epub 2019 Jan 1.

Digestive Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

The Guilan cohort study was conducted on 10520 men and women between 35-70 years of age in Guilan province and Some'e Sara county, northern Iran, from October 8, 2014 to January 20, 2017 as part of the Prospective Epidemiological Research Studies in Iran (PERSIAN). Eligible participants were contacted over the phone and were invited to refer to the cohort center. Demographic information was inquired during the phone call. Upon arrival of participants at the cohort center, consent forms were filled out and additional data on demographic characteristics, socio-economic status, employment, fuel status and location, lifestyle habits, and sleep and food habits were obtained. Blood pressure and anthropometric indices were measured. Finally, biological samples were collected. There was a participation rate of 83.2%, and a 15-year active follow-up was planned for all of the participants. The results showed that 53.5% of the participants were female and 56.1% of the participants were rural residents. A total of 1738 participants (16.5%) were illiterate. Of the total cohort participants, 4543 (43.2%) were hypertensive. Hypertension was defined as a systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg, or a prior diagnosis of hypertension by a health professional, or taking antihypertensive medications. Approximately one-third of participants (n=3435 or 32.7%) were obese, and most were females (n=2647, 77.1%). Prevalence of diabetes (defined as fasting blood sugar equal or higher than 126 mg/dL or history of diagnosis with diabetes or taking glucose lowering medication) was 24.1% (20.2 % in males and 27.3% in females). We also obtained laboratory samples for basic and genetic scientific research. According to laboratory evaluations, 3,585 (34.1%) of the participants had hematuria, and most of them were women (n=2151 or 60%). The preliminary results of our study demonstrate a high prevalence of metabolic risk factors for Non-Communicable Diseases and mainly cardiovascular diseases in Guilan province, which merit detailed investigation of their intricate relationships. The population-based design of the study as well as its large sample size were the main strengths of our cohort study that makes these investigations feasible. Researchers interested in using the information are invited to visit the following websites: http://www.gums. ac.ir/cohort and http://persiancohort.com/.
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January 2019

Efficacy of Transcranial Direct Current Stimulation in the Treatment: Resistant Patients who Suffer from Severe Obsessive-compulsive Disorder.

Indian J Psychol Med 2017 Sep-Oct;39(5):573-578

Department of Clinical Psychology, Islamic Azad University, Tonekabon, Iran.

Background: During the past years, significant efforts have been made to explain the biological backgrounds of obsessive-compulsive disorder (OCD). Cortical-subcortical and neurotransmitter models are used for explaining the symptoms of OCD, so our hypothesis is that brain's transcranial direct current stimulation (TDCS) can regulate the brain activities of the OCD patients. Thus, based on the mentioned issues, this research seeks to investigate the efficacy of TDCS in treatment-resistant patients who suffer from severe OCD.

Materials And Methods: The present study is a clinical trial research which was based on the available sampling method, 42 treatment-resistant patients who suffer from severe OCD were selected as research's samples (2015-2016). Medical intervention protocol in this study is TDCS cathode type that was done in 15 sessions for 3 consecutive weeks (each session was conducted for 30 min daily). Yale-Brown Obsessive-Compulsive Scale was used for evaluating the efficacy of TDCS method during the 1, 5, 10, and 15 sessions and it was also used for checking the 1 and 3 monthly follow-up phases.

Results: Variance within-group analysis (repeated measure) showed that the mean differences in the different stages of evaluation are significant (seven stages of evaluation).

Conclusion: TDCS can be introduced as an appropriate, strong tool for regulating the brain - behavioral systems and it can also be introduced as a suitable alternative treatment for treatment-resistant patients who suffer from severe OCD.
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http://dx.doi.org/10.4103/IJPSYM.IJPSYM_388_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688882PMC
December 2017

A Randomised Clinical Trial to Compare Coaxial and Noncoaxial Techniques in Percutaneous Core Needle Biopsy of Renal Parenchyma.

Cardiovasc Intervent Radiol 2017 Jan 30;40(1):106-111. Epub 2016 Sep 30.

Department of Radiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To compare the coaxial and noncoaxial techniques of renal parenchymal core needle biopsy.

Materials And Methods: This is an institutional review board-approved randomised controlled trial comparing 83 patients (male, n = 49) who underwent renal parenchymal core biopsy with coaxial method and 83 patients (male, n = 40) with noncoaxial method. The rate of complications, the number of glomerular profiles, and the procedural time were evaluated in a comparison of the two methods. Correlation between the presence of renal parenchymal disease and the rate of complication was also evaluated.

Results: The procedural time was significantly shorter in the coaxial technique (coaxial group, 5 ± 1 min; noncoaxial group, 14 ± 2 min; p < 0.001). The rates of complications for the coaxial method was significantly lower than the noncoaxial method (coaxial group, 10.8 %; noncoaxial group, 24.1 %; p = 0.025). There was no significant correlation between gender and the rate of complication. The number of glomerular profiles was significantly higher in patents who underwent renal biopsy with the coaxial method (coaxial group, 18.2 ± 9.1; noncoaxial group, 8.6 ± 5.5; p < 0.001). In the whole study population, the rate of complications was significantly higher in patients with a pathologic renal parenchyma compared to those with a normal parenchyma (19/71 vs. 10/95; p = 0.006).

Conclusions: Renal parenchymal biopsy using a coaxial needle is a faster and safer method with a lower rate of complications.
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http://dx.doi.org/10.1007/s00270-016-1466-3DOI Listing
January 2017

Transperineal Prostate Core Needle Biopsy: A Comparison of Coaxial Versus Noncoaxial Method in a Randomised Trial.

Cardiovasc Intervent Radiol 2016 Dec 2;39(12):1736-1742. Epub 2016 Aug 2.

Department of Radiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, 19998734383, Iran.

Purpose: To compare the procedural time and complication rate of coaxial technique with those of noncoaxial technique in transperineal prostate biopsy.

Materials And Methods: Transperineal prostate biopsy with coaxial (first group, n = 120) and noncoaxial (second group, n = 120) methods was performed randomly in 240 patients. The procedural time was recorded. The level of pain experienced during the procedure was assessed on a visual analogue scale (VAS), and the rate of complications was evaluated in comparison of the two methods.

Results: The procedural time was significantly shorter in the first group (p < 0.001). In the first group, pain occurred less frequently (p = 0.002), with a significantly lower VAS score being experienced (p < 0.002). No patient had post procedural fever. Haematuria (p = 0.029) and haemorrhage from the site of biopsy (p < 0.001) were seen less frequently in the first group. There was no significant difference in the rate of urethral haemorrhage between the two groups (p = 0.059). Urinary retention occurred less commonly in the first group (p = 0.029). No significant difference was seen in the rate of dysuria between the two groups (p = 0.078).

Conclusions: Transperineal prostate biopsy using a coaxial needle is a faster and less painful method with a lower rate of complications compared with conventional noncoaxial technique.
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http://dx.doi.org/10.1007/s00270-016-1437-8DOI Listing
December 2016

Lamotrigine Augmentation Versus Placebo in Serotonin Reuptake Inhibitors-Resistant Obsessive-Compulsive Disorder: A Randomized Controlled Trial.

Iran J Psychiatry 2016 Apr;11(2):104-14

Department of Community Medicine, Guilan University of Medical Sciences, Rasht, Iran. Email:

Objective: Serotonin reuptake inhibitors are frequently used in first-line treatments for patients with obsessive-compulsive disorder. Nevertheless, many of these patients do not respond well to initial therapy. The hypothesis of glutamatergic dysfunction in specific brain regions has been proposed in the pathophysiology of obsessive-compulsive disorder. This study was designed to evaluate the possible efficacy of lamotrigine, a glutamatergic agent in Serotonin reuptake inhibitors-resistant patients with obsessive-compulsive disorder.

Method: This study was a 12-week, double blind, randomized, placebo-controlled trial of adjunctive fixed-doses of lamotrigine (100 mg) to Serotonin reuptake inhibitors therapy in obsessive-compulsive disorder. Eligible subjects who had a total Y-BOCS of 21 or above were randomly assigned to receive adjunctive treatment with either lamotrigine (n = 26), or placebo (n = 27). Response to lamotrigine was defined as clinical improvement (>25% decrease in the total Y-BOCS score), which was administered at weeks 0, 8 and 12.

Results: At the endpoint (week 12), significant differences were observed in obsession, compulsion, and total Y-BOCS scores comparing lamotrigine to placebo (P = 0.01, 0.005 and 0.007 respectively). The mean reduction in obsession, compulsion and total scores in lamotrigine group was about 4.15, 4.50 and 8.73, respectively. Similarly, the mean reductions in the placebo group were 2.52, 2.56 and 5.07. Effect sizes for efficacy measureswerecalculatedbyCohen'sd, and it was calculated as 0.54 for the total YBOCS.

Conclusion: Our findings provide evidence that this augmentation is well tolerated and may be an effective strategy for patients with refractory obsessive-compulsive disorder.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947218PMC
April 2016

The effect of phototherapy on urinary calcium excretion in term neonates.

Saudi J Kidney Dis Transpl 2016 May;27(3):486-92

Department of Pediatrics, Guilan University of Medical Sciences, Rasht, Iran.

Phototherapy is the most common, most effective, and least dangerous treatment method for neonatal hyperbilirubinemia and is the treatment of the first choice for neonatal icterus. Hypocalcemia is one of the lesser-known complications of phototherapy. Some studies have shown a relationship between increased urinary calcium excretion and phototherapy-induced hypocalcemia. We aimed to assess the effect of phototherapy on urinary calcium excretion in term neonates. This before-after study was performed on 80 term neonates having hyper- bilirubinemia referred to the 17(th) Shahrivar Hospital, Rasht, Guilan Province, Northern Iran, over a one-year period from May 2013 to May 2014. Electrocardiography was performed to measure QTc in all neonates at admission and 48 h after phototherapy. Blood and urine samples were taken from all neonates before and 48 h after phototherapy. Phototherapy was performed using four lamps with similar wavelengths from a distance of 20 cm. The serum and urinary calcium and sodium levels and urinary creatinine level before and after phototherapy were measured and compared. Data were analyzed using SPSS software, version 16. The mean age of the study subjects was 7.01 ± 4.13 days. We did not find any significant difference between urinary calcium levels (P = 0.0001), urinary creatinine levels (P = 0.954), or the calcium/creatinine ratio (P = 0.086) before and after phototherapy. The neonates' mean ± standard deviation plasma as well as urinary sodium levels differed before and after phototherapy; the difference was not statistically significant (P = 0.658). Phototherapy might increase urinary calcium excretion although it does not cause hypocalcemia.
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http://dx.doi.org/10.4103/1319-2442.182381DOI Listing
May 2016

Effects of Administering Prophylactic Acetaminophen on Short-term Complications of Vaccination in 6-month-old Infants.

Int J Prev Med 2015 21;6:124. Epub 2015 Dec 21.

Pediatric Growth Disorders Research Center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Background: We aimed to assess the effects of administering prophylactic acetaminophen on short-term complications of vaccination in 6-month-old infants admitted to a private pediatric clinic in Rasht (Iran) during 2002-2013.

Methods: This quasi-experimental study was conducted on 696, infants aged 6-month-old admitted to a pediatric clinic in Rasht before vaccination during 2002-2013. Overall, 31 infants were excluded during the course of the study. While prophylactic acetaminophen was administered in 322 participants (intervention group), 343 infants (control group) received acetaminophen after vaccination. Data were collected by a checklist including complications such as fever, drowsiness, anorexia, seizure, long and excessive crying, mood change, pain, and wound at the site of injection, abscess, induration, limb swelling, and erythema. The time of occurrence of each complication was also recorded. Data were analyzed by Chi-square test in SPSS 16.0. P < 0.05 was considered significant.

Results: Six hundred sixty-five participants (49.6% boy) were assessed in this study. The intervention and control groups had no significant difference in terms of sex distribution (P = 0.53). Short-term complications occurred in 45% of the infants. The most common complications were erythema (24.4%), induration (19.9%), and low-grade fever (16.1%). There was a significant relation between administering prophylactic acetaminophen and the incidence of low-grade fever (P = 0.01), induration (P = 0.01), and anorexia (P = 0.03).

Conclusions: Our findings indicated the efficacy of prophylactic acetaminophen in reducing postvaccination complications in a population of Iranian infants. According to our findings, further research is required to determine the preferred dose and time of administering acetaminophen.
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http://dx.doi.org/10.4103/2008-7802.172380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736061PMC
February 2016

Tracheobronchial Foreign-Bodies in Children; A 7 Year Retrospective Study.

Iran J Otorhinolaryngol 2015 Sep;27(82):377-85

Community Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Introduction: Foreign-body aspiration is still considered one of the most important diagnostic and therapeutic issues for physicians. Mortality rates and the prevalence of diseases caused by foreign bodies in the airway are higher in children because of the relatively narrow airway and immature protective mechanisms. The aim of this study was to study the pattern of foreign-body aspiration in the tracheobronchial tree as well as the success rate of rigid bronchoscopy in children admitted to the Amir-al-Momenin Hospital, Rasht during 2007-2014.

Materials And Methods: In this cross-sectional descriptive study, the required data were collected from the medical reports of all children under the age of 14 years with suspected foreign-body aspiration who were admitted and underwent explorative rigid bronchoscopy from 2007-2014. The data recorded in the checklists were analyzed using SPSS V16.

Results: Out of 103 children with suspected foreign-body aspiration, a foreign body was seen in 74 children (71.8%) during bronchoscopy. Among 74 patients with a confirmed aspiration, 73% (54) were males and 27% (20) were females (P=0.68). The average age of the subjects was 34.82±33.4 months; 66.2% were aged 1-3 years. The most common complaints (symptoms) of patients were non-productive cough (48.6%), wheezing (44.3%) and respiratory distress (18.6%). The most common physical examination findings were unilateral decreased pulmonary sound (62.3%), generalized wheezing (26.1%), and crackles (17.4%). Sixty-three patients had a suspected history of foreign-body aspiration. The most frequently aspirated foreign bodies were nuts (peanuts). In total, 52.7% of foreign bodies were lodged in the right bronchial tree. In 95.9% of cases, the foreign body was completely extracted by bronchoscope. The majority of cases were admitted more than 24 hours after the occurrence of aspiration, and pneumonia was the most common complication.

Conclusion: Patient history, especially initial suspicion of aspiration, coughing, wheezing and respiratory distress, can be helpful in the diagnosis of foreign-body aspiration.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4639691PMC
September 2015

Diagnostic value of IL-6, CRP, WBC, and absolute neutrophil count to predict serious bacterial infection in febrile infants.

Acta Med Iran 2015 Jul;53(7):408-11

Pediatrics growth disorders research center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Since clinical manifestations of most febrile infants younger than three months old are nonspecific, differentiation of Serious Bacterial Infection (SBI) from self-limiting viral illness is a significant challenge for pediatricians. This study was performed to assess the diagnostic value of white blood cell count (WBC), Absolute Neutrophil Count (ANC), Interleukin -6 (IL-6) and C-reactive protein (CRP) level to predict SBI in febrile infants younger than three months old who were hospitalized. This was a diagnostic test validation study. In this prospective study, 195 febrile infants admitted to 17 Shahrivar Hospital underwent a full sepsis workup including blood, urine, cerebrospinal fluid cultures and chest radiography. WBC count, ANC and CRP and Il-6 level were measured in all patients. Serum IL-6 concentration was measured by Enzyme-linked Immunosorbent Assay test. Then diagnostic, values of these tests for predicting SBI was compared with each other. Of total cases, 112 (57.4%) infants were male. SBI was diagnosed in 29 (14.9%) patients. The most common type of SBI was Urinary Tract Infection (UTI). Serum IL-6 (³20pg/dl) had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 79/1%, 91.6%,75.4%, 60.3%, respectively and for CRP (³ 10mg/l) values were 81.6%, 89.8%, 78.2%, and 52%,respectively. The predictive values of CRP and IL-6 were higher than WBC and ANC. IL-6 and CRP are more valid and better diagnostic markers for predicting SBI than WBC count and ANC. CRP level seems to be an accessible and cost-effective marker for early diagnosis of SBI. Since by no marker we can totally rule out SBI in febrile infants < three months of age, it is recommended to administer systemic antibiotics until culture results become available.
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July 2015

Association of Soccer and Genu Varum in Adolescents.

Trauma Mon 2015 May 25;20(2):e17184. Epub 2015 May 25.

Student Research Committee, Guilan University of Medical Sciences, Rasht, IR Iran.

Background: Genu varum is a physical deformity marked by bowing of the leg. One of the risk factors of this musculoskeletal alignment is stress on the knee joint such as with exercise.

Objectives: Since the evaluation of genu varum has not been widely studies, this study was conducted to examine the association between genu varum and playing soccer.

Materials And Methods: Between Septembers 2010-2012, 750 soccer players and 750 non-soccer players 10-18 years of age were included in the study. A questionnaire of data including age, height, weight, body mass index (BMI), years of soccer participation, the average time of playing soccer per week, previous trauma to the lower limbs, history of any fractures of the knee, previous hospitalizations, and the distance of joint lines between the knees was assessed for all subjects. Chi-square, student t-test, and one-way ANOVA were used for statistical analysis by SPSS v.19.0 software. In all tests, a P value of less than 0.05 was construed as statistically significant.

Results: Both soccer players and controls had genu varum. However, the incidence of genu varum was higher in the soccer players (P = 0.0001) and it was more prevalent in the 16-18 year age group (P = 0.0001). The results revealed a statistically significant association between the degree of practices and the prevalence of genu varum (P = 0.0001). Moreover, previous trauma to the knees and practicing in load-bearing sports led to an increase in the degree of genu varum (P = 0.0001).

Conclusions: There was a higher incidence of genu varum in soccer players than in control adolescents; the stress and load imposed on the knee joint led to more severe genu varum.
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http://dx.doi.org/10.5812/traumamon.17184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4538725PMC
May 2015

Comparing the effect of topical anesthesia and retrobulbar block with intravenous sedation on hemodynamic changes and satisfaction in patients undergoing cataract surgery (phaco method).

Anesth Pain Med 2015 Apr 28;5(2):e24780. Epub 2015 Apr 28.

Anesthesiology Research Center, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Background: Cataract is one of the most common surgical procedures in the elderly. In most cases, the elderly have cardiac ischemia or chronic coronary diseases, which would lead to more ischemic events during general anesthesia. Therefore, surgeons and anesthetists prefer regional aesthesia to the general one owing to its more advantages and less complications.

Objectives: Therefore, this study aimed to compare topical method and retrobulbar block for pain intensity, patient's satisfaction, hemodynamic changes and intra and postoperative complications.

Patients And Methods: In a single-blinded clinical trial, 114 patients scheduled for cataract surgery, aged 50 to 90 years with ASA physical status of I-III, were randomly assigned to two groups under monitored anesthesia care as topical anesthesia and retrobulbar block. After the injection of intravenous sedation, which was the combination of midazolam 0.5-1 mg with fentanyl 0.5-1 µ/kg, patients received retro bulbar block or topical anesthesia. During the operation, heart rate, systolic and diastolic blood pressure, mean arterial blood pressure and arterial saturation of O2were measured every five minutes. In addition, pain (VAS) and satisfaction (ISAS) scores were recorded every 15 minutes, then at recovery and one hour after the ending of operation in the ward. Findings were statistically analyzed using SPSS 16.

Results: In this study, no significant association was found between age, gender, education and physical condition of patients in both topical and retro bulbar block groups. Comparison of pain based on VAS, satisfaction based on ISAS score and MAP in the studied periods had no significant differences between the two groups of patients undergoing cataract surgery. However, significant differences were found between the two groups (P = 0.045, 0.02, 0.042 and P < 0.05) regarding heart rate, systolic and diastolic blood pressure and arterial oxygen saturation percentage after 20-30 minutes of the operation.

Conclusions: Both methods, topical and retro bulbar block had similar impression in cataract surgery regarding analgesia and patient satisfaction. However, in non-complicated cataract surgeries with short duration, topical anesthesia may be the preferable method, because of non-invasiveness, appropriate analgesia, patient satisfaction and hemodynamic stability.
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http://dx.doi.org/10.5812/aapm.24780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377165PMC
April 2015

The family medicine specialty, learning from experience.

J Family Med Prim Care 2014 Oct-Dec;3(4):436-7

Department of Community Medicine, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Family medicine has been accepted as a model for Iranian health-care reform, but many debates have been raised since its establishment. Despite many successes achieved, this area of medicine is very challengeable. Family practice as a specialty is an innovation that has been introduced by the ministry of health and medical education in Iran. Although this approach seems sophisticated, learning from experience is the first step to avoid difficulties that may occur from this selection. Our goal is to declare strengths, weaknesses, opportunities, and threats of family medicine specialty.
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http://dx.doi.org/10.4103/2249-4863.148142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311358PMC
February 2015

Predicting difficulty score for spinal anesthesia in transurethral lithotripsy surgery.

Anesth Pain Med 2014 Oct 9;4(4):e16244. Epub 2014 Sep 9.

Urology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Background: Spinal anesthesia (SA) is the most common regional anesthesia (RA) conducted for many surgical procedures.

Objectives: The current study aimed to predict the difficulty score of SA, by which to reduce the complications and ultimately improve the anesthesia quality.

Materials And Methods: Transurethral Lithotripsy (TUL) surgery candidates were enrolled in this observational study from 2010 to 2011. Before SA, the patient`s demographic information along with the Body Mass Index (BMI), lumbar spinous process status, spinal deformity, radiological signs of lumbar vertebrae, and a history of spinal surgery or difficult SA were recorded, then the patients underwent SA in L3-L4 interspinous process space. Information about Cerebrospinal Fluid (CSF) visibility at the first attempt (easy SA) and the times of trying with shifting in that space or trying the second space (moderate SA) and the third space (difficult SA) were recorded. Multinominal regression and relative operating characteristic (ROC) curve were used for statistical analysis.

Results: Hundred and one patients were enrolled. Of these patients, 50 (49.5%) underwent SA by the first attempt of the first space, in 36 patients (35.6%) it was moderate and in 15 patients (14.9%) it was difficult. There was no significant relationship between difficulty score of SA and gender, age, height, and history of previous difficult SA. But there was a significant relationship between difficulty score of SA and lumbar spinous process status (P =0.0001), radiological profile of the lumbar spine (P = 0.0001), the status of lumbar deformity (P = 0.007), and BMI (P = 0.006). Then using the ROC curve to predict the difficult SA, the cutoff point was 8.5 with 86.7% and 86% sensitivity and specificity, respectively.

Conclusions: It seems that considering the clinical examination of patients before SA focusing on lumbar spinous process status, presence of lumbar deformity, calculation of BMI and radiological signs of lumbar vertebrae can be helpful in predicting SA difficulty.
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http://dx.doi.org/10.5812/aapm.16244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199214PMC
October 2014

Quality of life in psoriatic patients: a study using the short form-36.

Int J Prev Med 2014 Sep;5(9):1146-52

Department of Dermatology, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Background: Quality of life (QOL) is increasingly recognized as an important outcome measure in dermatology. Psoriasis has a great impact on QOL of patients, and has a strong effect on social relations, psychological status, and daily activities. This study describe and compare the impact of different grades of severity of psoriasis on QOL of patients in north of Iran.

Methods: This cross-sectional study was performed on 55 patients diagnosed with psoriasis and 55 healthy controls. The patients were selected by consecutive sampling from April to December 2006. The controls were recruited by simple random sampling among patient escorts. After obtaining written informed consent, all the members were included into the study. The Psoriasis Area and Severity Index (PASI) standard questionnaire was used to determine the severity of the disease. In addition, the short-form-36 questionnaire, which is validated for use in Iran, was employed. The gathered data were analyzed using the Stata (V 8.0, SE) (Copyright 1984-2003, Stata Corporation, 4905 Lakeway Drive Special Edition, College Station, Texas 77845 USA) and analyses of covariance (ANCOVA) test.

Results: Overall, The mean PASI scores was 5.4 ± 6.7, total QOL scores had a significant difference between patients and controls (61.1 ± 17.0 vs. 71.9 ± 22.4) (P < 0.05), especially in three domains: Role-physical (58.5 ± 23.3 vs. 70.8 ± 26.2), general health (43.8 ± 21.6 vs. 61.5 ± 27.3), and social functioning (62.7 ± 26.7 vs. 79.5 ± 27.5) (P < 0.01). Physical activities were affected in >50% of the cases. This figure significantly increased with the increasing severity of psoriasis. In addition, social relationships were disrupted in more than half of the patients, but with no significant difference between different grades of severity (P > 0.05). There is no significant difference between adjusted score of multiple domains of QOL in psoriatic patients according to PASI levels (ANCOVA, P > 0.05).

Conclusions: The physicians' awareness of the importance of patients' QOL in both physical and emotional aspects could improve and enhance the psychological evaluation of the psoriatic patient, which will promote his/her positive outcome. And, PASI score can't to predict the QOL really.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192777PMC
September 2014

Balance performance in older adults and its relationship with falling.

Aging Clin Exp Res 2015 Jun 7;27(3):287-96. Epub 2014 Oct 7.

Department of Otolaryngology, Otolaryngology Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, 41396-38459, Rasht, Iran,

Background And Aims: A normal consequence of aging is a general deterioration in a number of musculoskeletal and sensory systems that affect postural control and balance. The aim of this study was to evaluate history of falls among active older individuals in Iran, and estimate the risk factors for falls among this population.

Methods: A total of 448 active older subjects from rural region of Rasht city, Iran, were included. They were divided into three groups depending on their age: young-old (n = 266); middle-old (n = 154) and oldest-old (n = 28). We assessed balance performance by One-Leg Balance (OLB), Functional Reach (FR), Timed Up and Go (TUG) and Romberg tests.

Results: The fall rate (>2 in the last year) was 27.0 %. The cut-off point 13.75 s for TUG test showed 84.7 % sensitivity and 56 % specificity. Also the best cut-off point for OLB test was 12.7 s (63 % sensitivity and 83.5 % specificity). Logistic regression analysis revealed that age, BMI, diabetes, and failure in OLB, FR, and Romberg tests predicted fall risk. The decision tree classification of older individuals showed three categorical variables, which in their order of importance included diabetes, Romberg test, and OLB test.

Conclusions: This study revealed the value of history taking about diabetes as a predictor for existing falling. Decision tree technique showed that Romberg and OLB tests help in identifying older adults with balance problems. Given the incidence and consequences of falls among older adults, large-scale prospective studies on older individuals to identify those prone to falls are warranted.
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http://dx.doi.org/10.1007/s40520-014-0273-4DOI Listing
June 2015

Comparing the duration of the analgesic effects of intravenous and rectal acetaminophen following tonsillectomy in children.

Anesth Pain Med 2014 Feb 6;4(1):e13175. Epub 2014 Feb 6.

Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Postoperative pain control (especially, after adenotonsillectomy) has a very important effect on recovery time, hospitalization duration, hemodynamic disorders, bleeding, nausea, vomiting and medical costs.

Objectives: The aim of this study was to investigate and compare the effects of intravenous and rectal acetaminophen on controlling post-adenotonsillectomy pain in children, and duration of their analgesic effects.

Patients And Methods: In this randomized double-blinded clinical trial, 96 children aged 4 - 10 years old with ASA physical status I or II who were candidates for adenotonsillectomy surgery in Amir-al-Momenin Hospital, Rasht, Iran were entered into the study and randomly divided into two equal groups. Anesthesia in both groups was induced injecting fentanyl-thiopental and at racurium; afterwards is of lurane was used to maintain anesthesia. After anesthesia induction, one group received intravenous and the other one, rectal acetaminophen, and were later compared based on CHIPPS criteria.

Results: Data analysis indicated a significant relationship between reduction of postoperative pain and the use of intravenous or rectal acetaminophen (P = 0.0001); in group receiving IV acetaminophen, only 10.4% of patients had no pain whereas in group receiving rectal acetaminophen, this number reached 43.8%. Also, on 4 and 6 hour time intervals, pain in rectal acetaminophen receiving group was less than that in IV acetaminophen receiving group (P < 0.05). Demand for additional analgesic medication in rectal acetaminophen receiving group was less than that in IV group (P = 0.0001).

Conclusions: Post-operative pain in rectal acetaminophen group was less than that in intravenous acetaminophen group, and rectal acetaminophen group demanded their first additional analgesic medication later.
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http://dx.doi.org/10.5812/aapm.13175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961018PMC
February 2014

Evaluation of serum lead levels in children with constipation and normal controls in northern iran.

Iran J Pediatr 2013 Aug;23(4):417-22

Guilan University of Medical Sciences, Rasht, Iran.

Objective: Constipation is a major debilitating problem in children. We aimed to assess the serum lead levels of 2-13 year-old children complaining from constipation who referred to our center in Guilan province, Northern Iran.

Methods: This cross-sectional study was done on ninety 2-13 year-old children referring to 17(th) Shahrivar Hospital, complaining from constipation (case group) and 90 healthy children The demographic data as well as the children's serum lead levels were evaluated and recorded. Data were analyzed using SPSS software. Chi-square test was used as applicable.

Findings: Lead poisoning was significantly more frequent in the case group (37.8%) compared with the control group (8.9%). The frequency of lead poisoning in the case group compared with the control group, was significantly higher in children <7 years old (40.2% vs. 10%), boys (40.9% vs. 9.3%), girls (34.8% vs 8.3%), residents of old houses (43.1% vs. 9.7%), residents of new houses (28.1% vs. 8.5%), residents of low-traffic areas (26.8% vs. 5.3%), urban residents (40.5% vs. 9.9%), children whose fathers had low risk (33.3% vs. 10.9%) and high risk jobs (40.7% vs. 3.8%).

Conclusion: The frequency of lead poisoning was higher in children suffering from constipation.No significant difference was found between the two groups with respect to their sex, age, father's job, and living in urban or rural areas.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883371PMC
August 2013

Comparison of surgical conditions during propofol or isoflurane anesthesia for endoscopic sinus surgery.

Anesth Pain Med 2013 Sep 1;3(2):234-8. Epub 2013 Sep 1.

Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: The Anesthesia planning is an important and determining factor in the amount of intraoperative hemorrhage, which can affect the rate of intraoperative and postoperative complications.

Objectives: In this study we used two different anesthesia techniques in functional endoscopic sinus surgery (FESS) and compared the amount of hemorrhage in the two groups.

Patients And Methods: In a single-blind clinical trial, 44 patients with ASA class I and II candidate for FESS in Amir-Al-Momenin hospital in Rasht were entered the study and divided into two equal groups randomly. In both groups anesthesia was induced with propofol, remifentanil and cis. atracurium and then, infusion of propofol - remifentanil in the first group and isoflurane plus Remifentanil infusion in the second group was used for maintenance of anesthesia. Systolic blood pressure was maintained about 90 mmHg. Then on the basis of maximum allowable blood loss (MABL) formula, we calculated the percentage of hemorrhage. Finally the patients' hemorrhage was categorized into three groups (< 10%, 10-20%, > 20%). The surgeon's satisfaction from surgical field was calculated according to the Visual Analogue Scale. Then the data was statistically analyzed with T- test.

Results: There were meaningful differences between average of hemorrhage (propofol group = 155cc, and Isoflurane group = 291.3cc; P = 0.003), and surgeon's satisfaction (propofol group = 1.9 and Isoflurane group = 2.95; P = 0.007).

Conclusions: The amount of hemorrhage in propofol group was less than Isoflurane group and the field condition was better in propofol group than the Isoflurane group.
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http://dx.doi.org/10.5812/aapm.9891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833048PMC
September 2013

Imaging or trusting on surface anatomy? A comparison between fluoroscopic guidance and anatomic landmarks for femoral artery access in diagnostic cardiac catheterization. A randomized control trial.

Cardiovasc Interv Ther 2014 Jan;29(1):18-23

We performed a randomized controlled trial to test the potential benefits of fluoroscopic-guided femoral artery puncture. Observational studies showed a consistent relationship between common femoral artery (CFA) and the head of femur. Fluoroscopy locating the femoral head may increase the accuracy of femoral puncture and consequently decrease the vascular complication. Despite these theoretical benefits, we have no sufficient evidence to verify its advantages. Patients undergoing diagnostic cardiac catheterization were randomized into fluoroscopic and anatomic method groups. Of total of 609 patients participated in this study, 305 and 304 patients were assigned to fluoroscopic and anatomic method groups, respectively. Fluoroscopy significantly increases the puncture over the femoral head (96.7 vs. 82.3 %, p value 0.001) and also the fluoroscopic method increased CFA puncture significantly (93.8 vs. 87.5 %, p value 0.012). The combined end point of “proper” femoral puncture (CFA puncture over the femoral head) was highly significant in our fluoroscopy-guided method (91.8 vs. 75.7 %, p value <0.0001). Hematoma was the only vascular complication trough the study (2.6 % of patients) but no significant difference was seen between the two groups. In conclusion, our study showed the efficacy of fluoroscopy in increasing the proper femoral artery puncture, and although it did not show significant improvement in vascular complications, the method should be regard as an accurate guide for femoral access.
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http://dx.doi.org/10.1007/s12928-013-0203-yDOI Listing
January 2014

Hypercalciuria in school-aged children of Rasht: a single-center study.

Iran J Kidney Dis 2013 Jul;7(4):265-7

Division of Nephrology, Department of Pediatrics, Guilan University of Medical Sciences, Rasht, Iran.

Hypercalciuria is the most common identifiable metabolic cause of calcium kidney calculus disease. Idiopathic hypercalciuria is defined as hypercalciuria with normal serum electrolytes levels in the absence of any known underlying disease responsible for increased urinary calcium excretion. The aim of the present survey was to study the prevalence of urinary tract signs and symptoms of idiopathic hypercalciuria in a healthy group of primary school children living in Rasht, a city in north of Iran. The prevalence of idiopathic hypercalciuria in our study was estimated to be 5.6%. This is a first report of idiopathic hypercalciuria in Guilan province.
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July 2013

The influence of lateral and supine position on bacterial colonization of endotracheal tube in neonates admitted to neonatal intensive care unit.

Iran J Pediatr 2012 Dec;22(4):499-504

Guilan University of Medical Sciences, Rasht, Iran.

Objective: Recent data suggest that during mechanical ventilation, lateral patient position (in which the endotracheal tube is horizontal) decreases the incidence of bacterial colonization of ventilated neonates. The objective of this study was to evaluate the influence of lateral and supine position on bacterial colonization of endotracheal tube in neonates.

Methods: We conducted a prospective, randomized, clinical trial with 31 intubated neonates (intubated within 48 hours after birth); sixteen neonates were positioned supine (supine group), and fifteen were maintained in the lateral position (lateral group).Tracheal aspirates were cultured in second and fifth days of mechanical ventilation. Data were analyzed with SPSS version 16.

Findings: In the second day of ventilation, positive cultures were recognized in 6.2% of supine group and 6.7% of lateral group. After 5 days, tracheal cultures were positive in 25% (4 neonates) of supine group and 13.3% (2 neonates) of lateral group that wasn't statistically significant (P=0.9 in second day and P=0.9 in the fifth day). The most common organisms isolated from tracheal aspirates were Gram-negative rods (Klebsiella).

Conclusion: Since respiratory contamination is very common among ventilated neonates and the effect of lateral position on bacterial colonization of endotracheal tubes of intubated neonates wasn't established in our study, further studies are required to suggest ways to decrease bacterial colonization of intubated neonates.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3533151PMC
December 2012

Ultrasonic measurement of common carotid intima-media thickness in type 2 diabetic and non-diabetic patients.

Iran J Radiol 2012 Jun 30;9(2):79-82. Epub 2012 Jun 30.

Department of Radiology, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran.

Background: Diabetes mellitus is a widespread disease. Its vascular complications can be characterized by arteriosclerosis formation in carotid arteries. Due to its delayed diagnosis resulting in more complications in Iran, it seems that screening diabetic patients is mandatory.

Objectives: The aim of this study was to compare the intima-media thickness (IMT) of carotid artery in diabetic and non-diabetic patients.

Patients And Methods: This is a cross-sectional study, which included 80 participants (40 diabetics and 40 non-diabetics). By using ultrasound, bilateral IMTs of the distal carotid were measured and the data were analyzed using ANOVA and multivariate regression tests in SPSS 14.

Results: The mean IMT was 0.97 in diabetic patients and 0.63 in non-diabetics (P < 0.001). Age and gender had significant positive effects on the increase of IMT (P < 0.05 and P < 0.005, respectively for age and gender). Past medical history of coronary heart disease (CHD) and cerebrovascular accident (CVA) in diabetes is associated significantly with an increase in IMT (P =0.019 and 0.027 respectively). Other confounding variables such as smoking, history of hypertension (HTN) and hyperlipoproteinemia (HLP) in diabetic patients showed no significant relationship with the increase of IMT.

Conclusions: Although measuring the IMT of the carotid artery by sonography is a useful tool for screening diabetic patients, more studies are needed for determining how to use these measurements in promoting the patients outcomes.
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http://dx.doi.org/10.5812/iranjradiol.7564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3522355PMC
June 2012

Reasons given by mothers for discontinuing breastfeeding in Iran.

Int Breastfeed J 2012 May 6;7(1). Epub 2012 May 6.

Unit for Public Health Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.

Background: We have previously shown that in Iran, only 28% of infants were exclusively breastfed at six months, despite a high prevalence of breastfeeding at two years of age. The primary aim of this study was to investigate the reasons women discontinued exclusive breastfeeding.

Method: This retrospective study was based on questionnaires and interviews with 63,071 mothers of infants up to 24 months of age, divided into two populations: infants younger than six months and six months or older. The data were collected in 2005-2006 from all 30 provinces of Iran.

Results: Only 5.3% of infants less than six months of age stopped breastfeeding (mean age of 3.2 months); more commonly in urban than rural areas. The most frequently cited reasons mothers gave for discontinuing exclusive breastfeeding were physicians' recommendation (54%) and insufficient breast milk (self-perceived or true, 28%). Breastfeeding was common after six months of age: only 11% of infants discontinued breastfeeding, at a mean of 13.8 months. The most common reason for discontinuation at this age was insufficient breast milk (self-perceived or true, 45%). Maternal illness or medication (10%), infant illness (6%), and return to work (3%) were uncommon causes. Use of a pacifier was correlated with breastfeeding discontinuation. Maternal age and education was not associated with duration of breastfeeding. Multivariate analysis showed that using a pacifier and formula or other bottle feeding increased the risk of early cessation of breastfeeding.

Conclusions: Physicians and other health professionals have an important role to play in encouraging and supporting mothers to maintain breastfeeding.
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http://dx.doi.org/10.1186/1746-4358-7-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407704PMC
May 2012

Transurethral intraprostatic Botulinum toxin-A injection: a novel treatment for BPH refractory to current medical therapy in poor surgical candidates.

World J Urol 2013 Feb 13;31(1):235-9. Epub 2012 Mar 13.

Urology Research Center, Razi Hospital, Guilan University of Medical Sciences, Sardar Jangal St., Rasht, Iran.

Purpose: Benign prostatic hyperplasia (BPH) is the main cause of lower urinary tract symptoms (LUTS) in elderly men. Some patients respond poorly to routine medical therapy and are not well suited for surgery, too. This study was planned to evaluate the effect of Botulinum-A on BPH refractory to current medical therapy in poor surgical candidates.

Methods: In this clinical trial, 10 patients with LUTS suggestive of BPH who had responded poorly to medical therapy for at least 6 months and were poor surgical candidates, were received different doses of transurethral Botulinum-A injection based on their prostate volume. The prostate volume, PSA, Qmax, IPSS, PVR and frequency of nocturia were evaluated and compared before and after treatment.

Results: The mean IPSS was 24.50 ± 3.8 and 13.40 ± 2.67 before and after the treatment, respectively (P < 0.001). The mean prostate volume was decreased from 41.50 ± 10.85 mL to 30.40 ± 8.05 mL (P < 0.001). The Qmax was increased from 7.87 ± 2.01 mL/s to 16.19 ± 1.76 mL/s (P < 0.001). The mean PSA was 3.12 ± 0.49 ng/mL and 1.71 ± 0.39 ng/mL before and after treatment, respectively (P < 0.001). The mean PVR was 75.6 ± 51.63 mL and 63.50 ± 36.59 mL before and after treatment, respectively (P = 0.096). The mean number of nocturia was decreased from 4.1 ± 0.87 to 2.4 ± 0.84 (P < 0.001). The mean IPSS, Prostate volume, PSA and frequency of nocturia were decreased significantly. Although mean PVR was decreased but it wasn't statistically significant. The mean Qmax was increased significantly.

Conclusion: Intraprostatic injection of Botulinum-A may be an effective and safe treatment for symptomatic BPH in selected patients whose medical treatment has faced failure and are poor surgical candidates. Transurethral method could be selected as a preferable technique of injection.
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http://dx.doi.org/10.1007/s00345-012-0851-zDOI Listing
February 2013

Patterns of Care Seeking During Episodes of Childhood Diarrhea and its Relation to Preventive Care Patterns: National Integrated Monitoring and Evaluation Survey (IMES) of Family Health. Islamic Republic of Iran.

Int J Prev Med 2012 Jan;3(1):60-7

Department of Pediatrics, Faculty of Medicine, Ahwaz University of Medical Sciences, Rasht, Iran.

Background: In Iran, diarrheal disease is the fourth cause of under five-year mortality. Proper care-seeking behavior and system-based disease management in the national field will have a great effect in reducing morbidity and mortality.

Methods: This nationwide study was performed on a target population of rural and urban communities; in all 31 provinces of the Islamic Republic of Iran. One lakh three thousand three hundred and thirty one (103331) families were sampled by multi-stage stratified random sampling and were interviewed with a standard data collection form. The collected data was entered into the Stata 8.0 software and analyzed by the survey analysis method.

Results: Of the 14625 (10.1%) children who were reported to have diarrheal diseases two weeks prior to the interview, 8.8% were cured and 1.5% were not. About 70% of them had at least one visit for health seeking the most of patients were seen by a rural health worker (Behvarz) in the rural and by a general pediatrician in the urban areas. About 62% of the patients in urban and 57% in the rural areas had been treated with antibiotics and these rates for ORS were 51% and 65%, respectively. The factors most related to a care-seeking pattern were the level of routine preventive well-child care, number of siblings, child age, and living area.

Conclusion: According to this national survey, our health system needs to integrate all the levels of prevention, especially the Integrated Management of Child Illnesses (IMCI) programs with a family physician project. Futher more, there is a great need for empowering the referral system and gate keeping in all referral levels, to make efficient national integrated programs.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278871PMC
January 2012