Socioeconomic status and catastrophic health expenditure evaluation in IR Iran: A comparative study in 2004 and 2011

Background: Health equity is a main principle of all healthcare systems in the world. Family Physician (FP) program, as a health sector reform (HSR) in Iran, was executed to reduce households’ health care cost and to achieve health equity in 2004. Meanwhile, catastrophic health expenditure is known as an accepted indicator in HSR evaluation. In this context, after determining and comparing socioeconomic status (SES) among different periods, we made an attempt to evaluate households’ health financial protection in different quintiles after implementation of FP program.  Methods: The current cross-sectional study was based on the data obtained from Household Income and Expenditure Survey in 2004 and 2011. The health expenditures, catastrophic health expenditure (CHE), and SES were determined by this data during these years. Descriptive analyses and comparisons using Chi-squared test were carried out via SPSS, version 20.  Results: A total of 1716 households were included in the survey during 2004 and 2011. The highest proportion of households was related to quintiles very poor and poor with respect to each year. Moreover, it was observed that SES in 2011 had the worse situation compared to that in 2004; this situation was worse in urban areas. In the present study, CHE is related to poorer quintiles, and in rural areas no household was faced with CHE in 2011.  Conclusions: Implementation of FP program in rural areas with more primary care has prevented hospitalization. This was considerable for poorer quintiles and has led to financial protection for rural households

Bilateral hip septic arthritis caused by nontyphoidal Salmonella group D in a 16-year-old girl with COVID-19 : a case report

Introduction and importance Nontyphoidal Salmonella infection can lead to gastroenteritis, enteric fever, and bacteremia. However, joint infections due to this bacterium are rare, and usually associated with immunosuppressive disorders. Case presentation A 16-year-old girl, with a recent history of acute lymphocytic leukemia (ALL) presented with bacteremia, and bilateral hip pain after COVID-19 symptoms. Clinical presentation, laboratory features and imaging showed bilateral nontyphoidal Salmonella septic arthritis. We administered antibiotics, based on antibiotics susceptibility pattern of the isolated Salmonella. Clinical discussion The case is presented because reports of bilateral hip joint infection due to nontyphoidal Salmonella are rare especially after COVID-19. When the patient presents with joint discomfort, the clinician should think infection especially in immunocompromised hosts. Conclusion It illustrates successful management of septic arthritis requires prompt clinical diagnosis, microorganism identification, administration of appropriate systemic antibiotics and hip joint surgery

Comparison of effect of ventolin and hypersaline 3 on recovery course of acute bronchiolitis in hajar hospital, shahrekord in 2013-2014

Background and Objective: Acute bronchiolitis is one of the most common reasons for inflammation, small airways obstruction, and lower respiratory tract infection in infancy. Owing that there has been no study on the efficacy of hypersaline 3% in the treatment of acute bronchiolitis in Iran, the present study was undertaken to deal with this issue. Materials and Methods: This double-blinded clinical trial was carried out in Hajar Hospital of Shahrekord in 2013-2014. 70 patients under 2 years of age with bronchiolitis were assigned to two groups of 35 each. The first group received nebulized Ventolin while the second group was given nebulized hypersaline 3% three times a day. Subsequent to these administrations, recovery duration was compared in both groups. Results: The mean and standard deviation of recovery duration in the Ventolin group was 4.14±0.9 days and in the hypersaline 3% group was 3.06±0.6 days. T-test and mean recovery duration was significantly lower in the hypersaline 3% group (P<0.001). Conclusion: Nebulizer hypersaline 3% had a better therapeutic effect than Ventolin in the treatment of acute bronchiolitis. Therefore, the use of this drug, rather than Ventolin, is recommended for the treatment of acute bronchiolitis in children under two years of age. © 2016, Zanjan University of Medical Sciences and Health Services. All right reserved

Effect of phenobarbital on nitric oxide level in term newborn infants with perinatal asphyxia

Perinatal asphyxia (PA) is very significant in perinatal medicine due to the involvement of the central nervous system. This study was conducted to investigate the biochemical, clinical, and paraclinical changes associated with phenobarbital administration in neonates with PA. Methods: In this prospective, case-control study, 30 neonates with PA in two groups of 15 each (case and control) were investigated. The case group received 20 mg/kg intravenous phenobarbital within six hours of birth, and the control group did not receive phenobarbital. Serum concentrations of nitric oxide (NO) were measured at enrollment and one week after birth in the two groups. Clinical, electroencephalography, and magnetic resonance imaging findings of the two groups were compared. Results: At enrollment, the two groups did not differ in clinical severity, seizure incidence, or NO concentration. After one week, NO concentration was significantly lower in the case group (p < 0.050), but there was no significant difference in other variables between the two groups. Conclusions: Early administration of phenobarbital in term neonates with PA could protect them against encephalopathy

Frequency of T lymphocyte subsets in major beta-thalassemia patients and the influencing factors

زمینه و هدف: از راهکارهای رایج درمانی در بیماران تالاسمی تزریق خون های مکرر و درمان دفع آهن است. عوارض عفونی از مشکلات جدی در بیماران تالاسمی به حساب می آید که می تواند ناشی از ناهنجاری های ایمیونولوژیکی باشد. در مطالعه حاضر فراوانی زیر گروه های اصلی لنفوسیت های T و ارتباط آن ها با سن، میزان تزریق خون، فریتین سرم و درمان دفع آهن مورد بررسی قرار گرفته است. روش بررسی: در این مطالعه توصیفی- مقطعی 27 بیمار مبتلا به تالاسمی ماژور مراجعه کننده به بیمارستان هاجر شهرکرد در سال 1390 با محدوده سنی 30-10 سال که بر اساس معیارهای بالینی و آزمایشگاهی تشخیص داده شده بودند، شرکت کردند. گروه شاهد نیز شامل یک گروه 26 نفره از افراد سالم بودند که از لحاظ سن و جنس با بیماران مطابقت داشتند. نمونه خون وریدی در لوله های حاوی سدیم هپارین جمع آوری و پس از لیز گلبول های قرمز با آنتی بادی های منوکلونال نشاندار فلورسنت رنگ آمیزی گردید و مورد آنالیز فلوسایتومتریک قرار گرفت. تعداد سلول ها با توجه به نتایج آنالیز فوق و شمارش خونی محاسبه گردید. نتایج در نرم افزار SPSS و با استفاده از آزمون های M‏ann-Withney و همبستگی اسپیرمن تجزیه و تحلیل شدند. یافته ها: تعداد مطلق لنفوسیت ها در بیماران به صورت معنی داری بیش از گروه شاهد و درصد لنفوسیت های T به صورت معنی داری کمتر از گروه شاهد بود (001/0>P) . تعداد لنفوسیت های T در هر دو گروهCD4 و CD8 بین بیماران و گروه شاهد تفاوت معنی داری نداشت (05/

Therapeutic effects of Ventolin versus hypertonic saline 3% for acute bronchiolitis in children.

BACKGROUND Complications of Ventolin as the most common drug used for bronchiolitis are widely known. The present study was conducted to determine the efficacy of hypertonic saline 3%, compared with Ventolin, for treatment of acute bronchiolitis in children. METHODS This double-blinded clinical trial study was conducted in Hajar Hospital, Shahrekord, Iran, from 2011 to 2012. A total of 70 patients under the age of two years with bronchiolitis were divided into two groups of 35 each. Ventolin nebulizer and hypertonic saline 3% nebulizer three times per day were administered in the first (Ventolin) and second (Hypersaline) group, respectively. The length of recovery was compared between the two groups. The data were analyzed by SPSS software (version 22) using chi-square, t-test, paired t-test, and Mann-Whitney. RESULTS The mean±SD length of recovery was 4.14±0.9 and 3.06±0.6 in the Ventolin and hypersaline groups, respectively. The mean duration of recovery was significantly lower in the hypersaline group (p<0.001). CONCLUSION Hypertonic saline 3% nebulizer has more pleasant therapeutic effects on acute bronchiolitis than Ventolin. Therefore, use of hypertonic saline 3% nebulizer is recommended for the treatment of acute bronchiolitis in children under two years old

Effect of Topical Application of the Cream Containing Magnesium 2% on Treatment of Diaper Dermatitis and Diaper Rash in Children A Clinical Trial Study

Introduction: Diaper dermatitis is referred to the inflammation in outer layers of the skin in the perineal area, lower abdomen, and inner thighs. The lesions are maculopapular and usually itchy, which could cause bacterial or candida infection, and predispose the infants to penis or vaginal and urinary infection and lead to discomfort, irritability, and restlessness. The drugs which have been so far administered for this disease (topical steroids) cause special complications for the sensitive skin in this area. Magnesium (Mg) is known for its anti-inflammatory and wound-healing properties. Aim: The aim of the present study was to study the effect of the cream containing Mg 2% on treatment of diaper dermatitis and diaper rash in children. Materials and Methods: In this clinical trial study, 64 children aged less than two years old with diaper dermatitis referring Paediatric Ward of Hajar Hospital were randomly assigned to two groups of 32. Group one was treated with the combined cream Mg 2% and Calendula and group two with Calendula cream alone. The duration of recovery was compared between the two groups. Results: The duration of recovery was significantly lower in the intervention group than the control group (p-value<0.001), but there was no significant difference in the lesions size and diapers' number between the two groups. Conclusion: Based on the finding of this study, Mg is effective on treatment of diaper dermatitis and could be used for treating diaper dermatitis and other types of dermatitis

The Evaluation of Pelvic Cross Syndrome in Patients with Non-specific Chronic Low Back Pain

Objective: The purpose of this study was the investigation of relationship between muscle imbalance syndrome in the lumbo-pelvic area (Pelvic Cross Syndrome) which includes the combination of weakness of phasic muscles and tightness of postural muscles, lordosis and chronic low back pain. Materials & Methods: This study was a comparative - cross-sectional and case – control research. A convenience sample of 600 subjects participated in this study. The size of lordosis, strength of abdominal and gluteal muscles and the extensibility of iliopsoas and back extensor muscles were measured in each group. The best cut-off values obtained from Receiver Operating Characteristic (ROC) curve analysis were used to categorize subjects as having weak or tight muscles in accordance with the assumptions. The lumbar lordosis in subjects with and without patterns of muscle impairments, and the association between lordosis and low back pain was assessed. Data were analyzed by using statistical methods such as: ICC, Kolmogroff – Smirnoff, Independent T test and ANOVA. Results: The Findings of this study showed no significant difference in the degree of lordosis in subjects with and without patterns of muscle impairment in pelvic cross syndrome (P=0.38) and no significant difference in the lordosis between subjects with and without low back pain among those with specific patterns of muscle impairment in pelvic cross syndrome (P=0.62). Data also showed no significant association between degree of lordosis and low back pain (P=0.25). Conclusion: The findings of this study did not support the Pelvic Cross Syndrome theory, which indicates certain patterns of muscle impairment would lead to exaggerated LL and LBP. Our data show a relationship between muscle impairment and occurrence of LBP, but probably not via changing the degree of lumbar lordosis as it has been proposed in PCS theory

A rare testicular tumor with elevated alkaline phosphatase

Background: The majority of Leydig cell tumors (LCTs) are found in males, usually when they have 5–10 years of age. Children typically present with precocious puberty due to excessive testosterone secreted by the tumor, one-third of female patients present a recent history of progressive masculinization. Alkaline phosphatase is normally at low levels. Case Presentation: A 30-year-old male referred to the hospital with a complaint of fever, chills, nausea and weight loss, and history of diabetes mellitus type 1. In the physical examination of testis, no abnormal findings were revealed. Scrotal ultrasonography demonstrated a small (7.5 ×4.8 mm) mass which seemed to be very vascular and suggestive of neoplastic lesion. Echogenicity of the head of the right epididymis was heterogeneous and the small cyst of about 4.5 mm was present on it. Left testis had normal size and no space occupying lesion in it. The hormonal test revealed high levels of alkaline phosphatase, ferritin, FSH and LH, normal level of testosterone, LDH, β-HCG and α-feto-protein. Immunohistochemistry results revealed negative CD30, alpha-fetoprotein and CK results, but calretinin, vimentin and S-100 were positive in tumor cells. Conclusions: LCTs are rare testicular tumors arising from male gonadal interstitium and very rare in adulthood. Because this tumor consists of immature embryonic tissues it can be accompanied by an elevation in alkaline phosphatase level

The c.1243T>C mutation in the PROC gene is linked with inherited protein C deficiency and severe purpura fulminans

Key Clinical Message Purpura fulminans is a severe coagulation disorder that often leads to death in neonates. Mutations in the protein C (PROC) gene can cause protein C deficiency, leading to this disorder. This study aimed to investigate a family with a history of coagulopathies, particularly those related to protein C deficiency. The primary objective was to identify any genetic mutations in the PROC gene responsible for the coagulopathies. The study focused on a male neonate with purpura fulminans who ultimately died at 2 months of age. The patient had low protein C activity levels (6%). The entire PROC gene of the patient and his family was analyzed using next‐generation sequencing to identify any genetic mutations. Segregation analysis was conducted to determine if the mutation followed an autosomal dominant inheritance pattern. In silico analysis was also conducted to evaluate the pathogenicity of the identified mutation. Analysis revealed a novel homozygous c.1243T>G variant PROC gene. The mutation resulted in a Phe415Val substitution. The mutation was found in at least three generations of the family. Carrier family members had lower protein C activity levels than wild‐type homozygotes. Additionally, the mutation may account for the observed reduction in protein C enzyme activity