Cost-effectiveness of Methadone Maintenance Treatment in prevention of HIV among drug users in Shiraz, south of Iran

Background: The increase in high-risk injections and unsafe sexual behaviors has led to increased HIV infection prevalence among Intravenous Drug Users (IDUs). The high costs of HIV/AIDS care and low financial resources necessitate an economic evaluation to make the best decision for the control of HIV/AIDS. Objectives: This study was conducted to determine the cost-effectiveness of Methadone Maintenance Treatment (MMT) centers in HIV infection prevention among drug users. Materials and Methods: In this interventional study, we included all the seven MMT centers and the drug users registered there (n = 694). We calculated all the costs imposed on the government, i.e. Provider of case. Mathematical models were used to estimate the number of HIV cases averted from high-risk behaviors. Sensitivity analyses were performed to show the effects of uncertainty in parameters on the number of HIV cases averted and also Incremental Cost-Effectiveness Ratio (ICER). Results: Based on the averted models, the selected MMT centers could prevent 128 HIV cases during 1 year. The total cost was $547423 and that of HIV/AIDS care in the no intervention scenario was estimated$ 14171816. ICER was $106382 per HIV case averted. The results of the sensitivity analysis indicated that MMT intervention was cost-effective even in the worst scenario and ICER varied from$ 39149 to $ 290004 per HIV case averted. Conclusions: With regard to the high prevalence of drug injection among drug users and considering the high effectiveness and cost-effectiveness of MMT centers in preventing HIV infection, establishment of MMT centers in regional and national levels seems reasonable. © 2013, Iranian Red Crescent Medical Journal

Epidemiology of urinary tract infection and antibiotic resistance pattern of E. coli in patients referred to Imam Ali hospital in Farokhshahr, Chaharmahal va Bakhtiari, Iran

زمینه و هدف: عفونت دستگاه ادراری یکی از شایع ترین عفونت های بیمارستانی است که الگوی مقاومت آنتی بیوتیکی آن در مناطق گوناگون متفاوت است. هدف این مطالعه تعیین فراوانی عوامل باکتریال ایجاد کننده عفونت ادراری و الگوی حساسیت و مقاومت آنتی بیوتیکی اشرشیاکلی (E. coli) در مراجعین سرپایی به مجتمع بیمارستانی امام علی(ع) فرخشهر بود. روش بررسی: در این مطالعه توصیفی تحلیلی، در یک مدت 5 ماهه (بهمن1390 تا خرداد 1391) از تعداد 848 نفر بیمار مشکوک به عفونت ادراری مراجعه کننده به بیمارستان امام علی(ع)، نمونه ادرار جمع آوری شد. پس از جدا سازی عامل عفونت، با روش Clinical and Laboratory Standards Institute آزمون حساسیت به آنتی بیوتیک انجام شد. داده ها با استفاده از آزمون آماری مجذور کای تجزیه و تحلیل شدند. یافته ها: از میان 848 نمونه واجد شرایط، نتیجه آزمایش کشت ادرار 74 نفر (72/8) مثبت بود. باکتری E.coli با 52 مورد (27/70) و باکتری استافیلوکوکوس با 15 مورد (27/20) شایع ترین باکتری‌های جداسازی شده بودند. از 52 نفر آلوده به باکتری E.coli 34 نفر (38/65) زن و 18 نفر (62/34) مرد بودند. بر اساس نتایج آنتی بیوگرام بیشترین موارد مقاومت، به ترتیب مربوط به آنتی بیوتیک آمپی سیلین (71/85)، نالیدیسیک اسید (78/78) و سیپروفلاکسین (51/46) بود. از سوی دیگر، بیشترین حساسیت مربوط به آنتی بیوتیک های نیتروفورانتوئین (30/92)، آمیکاسین (67/66) و جنتامایسین (50/62) بود. بیشترین موارد عفونت در رده ی سنی بالاتر از 47 سال مشاهده گردید. نتیجه گیری: آمپی سیلین و نیتروفورانتوئین به ترتیب دارای بیشترین میزان مقاومت و حساسیت آنتی بیوتیکی بوده اند و براساس نتایج بدست آمده، درمان تجربی با آمپی سیلین در اکثر بیماران مبتلا به عفونت ادراری مناسب نیست

Modeling Compressible Non-Newtonian Chicken Flow

This paper addresses a few modeling issues relevant for the basic theoretical understanding of the meat flow behavior in simple geometries. We model the meat mixture as a non-Newtonian compressible fluid. Focusing on conceptually easy-to-follow cases like flow in thin molds, or steady incompressible or compressible flow in straight pipes we derive explicit expressions for the velocity and pressure profiles. For the thin moldcase, we formulate a one-dimensional free-boundary problem able to capture the a priori unknown position of the moving meat-air interface. Special attention is payed on the derivation of the free boundary conditions

Numerical simulation of detonation failure and re-initiation in bifurcated tubes

A numerical approach is developed to simulate detonation propagation, attenuation, failure and re-initiation in hydrogen–air mixture. The aim is to study the condition under which detonations may fail or re-initiate in bifurcated tubes which is important for risk assessment in industrial accidents. A code is developed to solve compressible, multidimensional, transient, reactive Navier–Stokes equations. An Implicit Large Eddy Simulation approach is used to model the turbulence. The code is developed and tested to ensure both deflagrations (when detonation fails) and detonations are simulated correctly. The code can correctly predict the flame properties as well as detonation dynamic parameters. The detonation propagation predictions in bifurcated tubes are validated against the experimental work of Wang et al. [1,2] and found to be in good agreement with experimental observations

Acute lymphocytic leukemia with severe eosinophilia (a case report)

زمینه و هدف: لوسمی حاد لنفوئیدی (ALL) یک سرطان بدخیم است و همراهی آن با افزایش ائوزینوفیل ها بسیار نادر رخ می دهد. در این مطالعه یک مورد لوسمی حاد لنفوئیدی با تظاهرات افزایش شدید ائوزینوفیل ها گزارش می گردد. گزارش مورد: در این گزارش یک پسر 18 ساله مبتلا به ALL همراه با افزایش شدید ائوزینوفیل ها، خستگی، تب خفیف، تپش قلب، ضعف دوره ای و اریترودرمی منتشر معرفی و در معاینات اولیه تنها طحال بزرگ مشاهده شد. در شمارش سلول های خون محیطی، تعداد گلبول های سفید ۵۰۰۰۰ گزارش شد که ۶۰ آن را ائوزینوفیل ها تشکیل می دادند. میزان هموگلوبین و پلاکت طبیعی بود. در آزمایش مغز استخوان، افزایش سلولاریتی به همراه افزایش تعداد ائوزینوفیل ها و لنفوبلاست ها نشان داده شد. آزمایش فلوسیتومتری بر روی سلول های خون محیطی و مغز استخوان حاکی از تشخیص لوسمی پیش ساز لنفوئید B بود. بیمار تحت درمان با رژیم دارویی CVAD با دوز بالا قرار گرفت که پاسخ نداد و بنابراین تحت درمان با رژیم دارویی FLANG قرار گرفت که منجر به بهبودی بیماری وی گردید. در نهایت بیمار برای پیوند آلوژن مغز استخوان ارجاع شد. نتیجه گیری: با توجه به گزارش حاضر توصیه می شود در بیماران با افزایش شدید ائوزینوفیل ها به بیماری ALL نیز توجه شود و اقدامات لازم و به موقع در تشخیص بیماری به عمل آید

Investigating the level of moral distress and its related factors among nurses in mazandaran burn center

Background and purpose: Moral distress is a common phenomenon in nursing professional and burn nurses are constantly faced with making different moral decisions for patients who are in terrible conditions. Therefore, nurses in burn units experience moral distress as mental tension. This study was conducted to determine the severity of moral distress and the factors associated with that in burn nurses. Materials and methods: A descriptive- analytical study was conducted using census sampling on 172 nurses working in Mazandaran burn center, 2014. Data was collected through identifying demographic and occupational characteristics of the nurses (using relevant questionnaires) and Corley’s Moral Distress Scale. Data analysis was performed applying Mann-Whitney and Kruskal-Wallis test. Results: The mean score for moral distress was 105.65±52.39 which indicates a moderate level experienced by nurses. Kruskal-Wallis test showed a significant positive correlation between educational level and level of moral distress (P=0.011). There was no significant association between moral distress and other individual and professional characteristics (P>0.05). Conclusion: Moral distress is accompanied by many complications that have direct effects on nurses’ professional practice. Therefore, nurse managers should consider this issue and plan for programs on appropriate coping strategies. © 2015, Mazandaran University of Medical Sciences. All rights reserved

Analysis of changes in viticultural climatic indices in northwestern and western Iran

Climate and climatic variables are very important factors in grape growth. Usually, temperature variables (maximum, average and minimum), as well as pre-cipitation variables (annual, monthly and daily), are used to determine the regional climate and to study the type and amount of climate change. Most of the viticultural climatic indices presented by researchers have been using the above variables. Northwestern and western regions of Iran are considered as the most important areas of grape cultivation with different climatic conditions in different parts that have led to the cultivation of grape cultivars. In this study, five temperature indices (Huglin, latitude-temperature, night cooling, temperature variability and Winkler) and two precipitation indices were investigated based on De Martonne and hydrothermal drought indices. Then, they were analyzed by Mann-Kendall method and Sen's slope estimator index. The studies showed significant positive trends in Huglin, Winkler, night cooling and latitude-temperature indices, while the temperature variability index is significant only in a few stations. On the other hand, the indices related to drought and hydrothermal show no trend. However, some southern stations in the region showed a different trend in some indices. As a result, the trend of changes in temperature indices can lead to the expansion of cultivation of grape cultivars in the coming years, although the limitation of water resources will be a negative factor