10 research outputs found
Obstacles of ending TB: What does health system think?
Background: Despite the importance of Tuberculosis (TB) control program and elimination of disease as its target, only a few studies have been carried out to evaluate tuberculosis control in Iran. In the present study, we intended to ask the opinions from experts and managers of Iran University of Medical Sciences about the TB control program in Iran.Methods: A Qualitative study was carried out to determine experts’ and managers’ opinions about the national TB control program. Experts and stakeholders were listed for focus group discussions (FGD) and interviews using purposive sampling method. We interviewed all levels of staff involved in the tuberculosis control program (managers, physicians, and administrative and executive staffs). Three FGD sessions were held with 28 participants. The participants were excluded if they had less than six months of experience in TB program. FGD and interviews were manually coded and the themes and sub-themes were extracted. After analyzing the results, the final report was drafted. Results: The results were classified into four themes and 15 subthemes (6 in input, 3 in process, 2 in outputs, and 4 in outcome). There were positive points and problems in each part. To achieve the goal of End TB, we will need to review the process, incorporate with other sectors, apply new diagnostic methods, and participate with other stakeholders (internal and external).Conclusion: Because of the effects of socio-economic factors on tuberculosis, considering the current implementation of the program; it is not possible to eliminate tuberculosis.
The Effect of Rheum ribes Root (Rhubarb) on Menopausal Hot Flashes: a Randomized Double-Blind, Placebo-Controlled Trial
Background and objectives: Hot flashes are one of the most predominant complaints of menopause among women. The main treatment is hormone replacement therapy, which has side effects. Therefore, the use of plants with phytoestrogen has been suggested as an adjunctive treatment. This study aimed to estimate the efficacy of processed rhubarb (Rheum ribes L.) on hot flashes in postmenopausal women. Methods: This double-blind placebo-controlled trial was performed on postmenopausal women who were referred to public health centers at Iran University of Medical Sciences. Ninety postmenopausal women aged over 45 years with menopausal hot flashes were randomly assigned to two groups. The treatment group received 500 mg of encapsulated processed R. ribes twice a day for eight weeks, and the control group received placebo (starch powder) in the same manner. Data were collected using Blatt–Kupperman index at the start of the study, fourth and eighth weeks after the intervention. Descriptive and analytic statistics were used to analyze the data. Results: A total of 74 patients completed the study (39 participants in the intervention group and 35 in the control group). The results showed that R. ribes significantly decreased the mean of flashing in Blatt–Kupperman index four and eight weeks post-intervention (p<0.001). Rheum ribes showed no serious adverse effects. Conclusion: The findings of this study propose that treatment with R. ribes may be considered an adjunctive treatment for hot flashes in postmenopausal women
Progress towards Every Newborn Action Plan (ENAP) implementation in Iran:obstacles and bottlenecks
Background: Neonatal mortality accounts for more than 47% of deaths among children under five globally but proper care at and around the time of birth could prevent about two-thirds of these deaths. The Every Newborn Action Plan (ENAP) offers a plan and vision to improve and achieve equitable and high-quality care for mothers and newborns. We applied the bottleneck analysis tool offered by ENAP to identify obstacles and bottlenecks hindering the scale-up of newborn care across seven health system building blocks. Methods: We applied the every newborn bottleneck analysis tool to identify obstacles hindering the scale-up of newborn care across seven health system building blocks. We used qualitative methods to collect data from five medical universities and their corresponding hospitals in three provinces. We also interviewed other national experts, key informants, and stakeholders in neonatal care. In addition, we reviewed and qualitatively analyzed the performance report of neonatal care and services from 16 medical universities around the country. Results: We identified many challenges and bottlenecks in the scale-up of newborn care in Iran. The major obstacles included but were not limited to the lack of a single leading and governing entity for newborn care, insufficient financial resources for neonatal care services, insufficient number of skilled health professionals, and inadequate patient transfer. Conclusions: To address identified bottlenecks in neonatal health care in Iran, some of our recommendations were as follows: establishing a single national authorizing and leading entity, allocating specific budget to newborn care, matching high-quality neonatal health care providers to the needs of all urban and rural areas, maintaining clear policies on the distribution of NICUs to minimize the need for patient transfer, and using the available and reliable private sector NICU ambulances for safe patient transfer.</p
Comparative evaluation of normal saline, 1/3-2/3, and ringer's lactate infusion on labour outcome, PH, bilirubin, and glucose level of the umbilical cord blood in nulliparous women with labour induction: a randomised clinical trial
This study aimed to compare the effects of infusion of normal saline, 1/3-2/3, and Ringer's lactate fluids on labour outcome, pH, bilirubin, and glucose level of umbilical cord blood. In this randomised clinical trial, 450 nulliparous women with Bishop score ˂5 and indication of pregnancy termination were randomly divided into three groups to receive normal saline, 1/3-2/3, or Ringer's lactate infusion at a rate of 125 mL/h for hydration, upon starting induction of labour. Results of this study indicated that the incidence of hypoglycaemia (p = .19), hyper bilirubinemia (p = .87) and acidosis (p = .10) was similar in neonates of the three groups. Also, there were no statistically significant differences between the three groups with regard to the duration of labour; glucose, bilirubin and pH level of cord blood; and mode of delivery. It can be concluded that infusion of Ringer's lactate, normal saline or 1/3-2/3 fluid during labour is not associated with different maternal or foetal/neonatal outcomes, and none of the fluids has superiority to the others.Impact statement What is already known on this subject? Several studies have been conducted on the association between type and volume of infused fluid on labour duration and neonatal outcomes. However, there has been some controversy. What do the results of this study add? This is the first study that has investigated the association between infusion of Ringer's lactate, normal saline or 1/3-2/3 fluid during labour with labour outcome and pH, bilirubin, and glucose level of the umbilical cord blood and results showed that these fluids have no effect on maternal or foetal/neonatal outcomes and also none of these fluids has superiority to the others. What are the implications of these findings for clinical practice and/or further research? Due to contradictory results of previous studies, further research with greater sample sizes and different fluids type and volumes may be needed to examine the association between infusion of fluids and neonatal and labour outcomes more precisely
Dientamoeba fragilis diagnosis by fecal screening: relative effectiveness of traditional techniques and molecular methods
Breast cancer survival rate according to data of cancer registry and death registry systems in Bushehr province, 2001-2013
Background: Breast cancer is the most common female cancer worldwide. Survival rate of breast cancer, especially as an indicator of the successful implementation of screening, diagnosis and treatment programs, has been at the center of attention of public health experts Material and Methods: In a survival study, the records of breast cancer cases in cancer registry system of Bushehr Province were extracted during 2001, March to 2013, September. These records were linked and matched with records of death registry system. After determining patients, status regarding being alive or dead, survival analysis was done. Life table, Kaplan-Mayer analysis, log rank and Breslow tests were used for computing and comparing survival rates. Results: In 300 recorded breast cancer cases, mean and standard deviation of age was 51.26±13.87. Survival rates were 95, 88, 78, 73 and 68 percent since the first year through the fifth year, respectively. Mean survival was 87.20 months (95% CI= 81.28- 93.12). There was no significant difference in mean survival regarding age and different geographical areas. Conclusion: Although survival rates of registered breast cancer patients in Bushehr Province are similar to other provinces, they are far from those of developed countries. This situation demands more extensive efforts regarding public education and improving the process of diagnosis, treatment and care of patients especially during first two years after diagnosis
Molecular Detection of Pneumocystis jirovecii in the Bronchoalveolar Lavage Samples in Patients with Various Pulmonary Disorders(Original Article)
Background: Pneumocystis jirovecii (P. jirovecii) causes Pneumocystis pneumonia (PCP) in people, especially the immunocompromised ones. It is also one of the serious causes of numerous lung problems in affected patients. Since documented data about P. jirovecii is not available in patients with pulmonary infections in Tehran, this study aimed to investigate the molecular epidemiology and parasitology of Pneumocystis to determine the frequency of the organism infection.
Methods: Bronchoalveolar lavage (BAL) samples were collected for 367 patients hospitalized in the lung department of Shariati Hospital in Tehran from July 2022 to July 2023. The samples were analyzed using Giemsa staining and molecular methods. After DNA extraction from samples, Nested polymerase chain reaction (Nested PCR) was employed for the amplification of the 18SrRNA gene and identification of P. jirovecii. The PCR products of Nested PCR were sequenced for final confirmation.Â
Results: Out of 367 samples, only one sample (0.27%) and 28 samples (6.7%) were found to be positive through parasitology and NestedPCR analysis, respectively. P. jirovecii was detected in seven (25%) and 21 (75%) immunocompromised and immunocompetent patients, respectively. Fever, shortness of breath and dry cough were the most common clinical symptoms among patients with Pneumocystosis. Patients with pulmonary disorders are prone to colonization by pneumocystis, which increases the risk of pneumocystosis and makes them a reservoir for transmission to susceptible people.
Conclusion: It can be concluded that patients with distinct lung disease are prone to colonization by Pneumocystis and, importantly, are at risk of infection. Also, according to the current study, Nested PCR was a suitable method for detecting P. jirovecii organisms because it had a very high sensitivity and specificity
Predictors of COVID-19 vaccine uptake among people who use substances: a case study in Tehran
Abstract Background Vaccination is one of the most effective ways to manage infectious disease epidemics such as Covid-19. However, the low rates of vaccination in populations at risk including people using illicit substances, hinders the effectiveness of preventive vaccines in reducing transmission. The aim of this study was to investigate the rate of Covid-19 vaccination and its related factors among people who use substances in Tehran, Iran. Methods Between July and December 2022, 386 people who use substances aged ≥ 18 years old were recruited by convenience street-based sampling in Tehran. The outcome variable in this study was self-reported completion of at least two doses of the Covid-19 vaccine. Logistic regression was used to investigate the factors related to Covid-19 vaccination. Data were analyzed using SPSS software version 20 at the 0.05 level of significance. As a measure of risk, 95% Confidence interval (CI) was used. The level of significance was considered at 0.05. Results Almost three-quarters (n = 286) of the participants reported receiving at least two doses of the Covid-19 vaccine (95% CI, 70.2–79.3). Those participants with high school diplomas were 1.17 times more likely than less educated participants to report having had 2 vaccinations (OR of 1.17, CI 95%: 1.03–1.81). Participants with a higher mean score of having a positive attitude towards Covid-19 vaccination were more likely to have received a vaccination (OR of 1.12, CI 95%: 1.08–1.17). Ethnicity was also an influential variable, people with non-Fars ethnicity were less likely to be vaccinated than those of Fars ethnicity (OR of 0.33, CI 95%: 0.13–0.81). People with higher-than-average monthly income were more likely to report vaccination than those with low monthly incomes (OR of 1.27, CI 95%: 1.09–1.8). Also, participants reporting less access to vaccination centers had a lower chance of reporting having been vaccinated than those who reported high access to vaccination centers (OR of .17, CI 95%: .08-.36). Conclusions Covid-19 vaccine uptake was found to be relatively high among people using illicit substances in this study. Higher levels of education, Fars ethnicity, higher income levels, having a positive attitude towards vaccination and access to vaccination centers were the most important predictors of Covid-19 vaccination in this study