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عضویت

جستجوی مقالات مرتبط با کلیدواژه « Rate » در نشریات گروه « پزشکی »

  • Leila Sayadi, Ali Karimi Rozveh, Samira Norouzrajabi
    Background

    Given the importance of implementing lung protective strategies to prevent lung injury caused by ventilators and death of patients, it is necessary to monitor the current condition of hospitals and examine the relationship between the parameters set on the ventilators and patient mortality. This study conducted to determine the current state of ventilator setting and their relationship with mortality rate in patients under mechanical ventilation: a cross-sectional study.

    Methods

    This is a cross-sectional study that was conducted between June to December 2020 in one of the hospitals affiliated to Tehran University of Medical Sciences. The initial tidal volume set on the ventilator was recorded for 304 patients under mechanical ventilation and then, their heights were measured and their tidal volumes were determined based on the standard formula. Other parameters set on the ventilator as well as systolic and diastolic blood pressures of patients were also recorded and their survival rate was investigated. The data was analyzed by SPSS software, using descriptive statistics and logistic regression model.

    Results

    Among patients, who were under mechanical ventilation, 77.6% were hospitalized in intensive care units and the rest were hospitalized in general wards. The mean adjusted tidal volume for patients was 472.91 ± 32.13 ml. The mean peak inspiratory pressure and plateau pressure were 28.00±6.98 and 13.88±4.93 CmH2O, respectively. Also, 37.2% of patients died during the hospitalization. The results of adjusted odds ratio based on multivariate logistic regression model for predictors of mortality rate showed that the variables of patients' age [OR=1.040 (1.019-1.062)], the hospital’s general ward in comparison with the ICU [OR=11.379 (5.130-25.240)] and the peak inspiratory pressure [OR=1.072 (1.007-1.141)] had a direct and significant relationship with mortality rate (in all cases P<0.05). Meanwhile, the plateau pressure [OR=0.886 (0.808 -0.972)] had an inverse and significant relationship with mortality rate (P<0.05).

    Conclusion

    Despite the recommendations regarding lung protective strategies, in some cases, some parameters set in the ventilator are outside the recommended levels, which can effect on patients mortality. So monitoring and controlling the implementation of lung protective strategies and paying attention to controlling pressures set on the ventilator are among measures that should be taken in medical centers in order to prevent lung injuries and maintain patient safety.

    Keywords: Ventilator, Parameters, Lung Protective Strategies, Mortality, Rate}
  • Talieh Zarifian, Atieh Ashtari*, Reza Nilipour, Shahin Nematzadeh, Narges Bayat
    Objectives

    Reading impairments are the most prevalent problem at school. It is vital to have a valid and reliable test to assess the student’s reading skills. This study aims to develop the KHANA test as a valid and reliable test to evaluate reading skills in Persian-speaking students and study the accuracy, rate, and reading comprehension in different grades and genders

    Methods

    This study included 87 students from second to seventh grade (75 typically developing students [TDS] and 12 students with reading impairments [SRI]). First, two preliminary parallel forms of student books, A and B, were prepared, both including 12 reading passages organized based on increasing difficulty as the student moved from one passage to the next. All the passages contain five comprehension questions. Then, the content and face validity, descriptive statistics, construct validity, and reliability, including test re-test, inter-rater, and the correlation between passages A and B were measured. 

    Results

    Based on the results, all the passages and questions were valid. The passages can make significant differences in reading skills between different grades, while gender differences are limited. However, according to the test re-test analysis, the inter-rater reliability, and the correlation between the two passages, KHANA is a reliable tool and can discriminate SRI from TDS.

    Discussion

    According to the results, KHANA seems a valid and reliable test to assess reading skills in Persian-speaking students from second to seventh grade.

    Keywords: Reading skills, Rate, Accuracy, Comprehension, Reading impairment, Assessment, KHANA}
  • Hind Bennani *, Morad Guennouni, _ Assia El Ouarradi, _ Asmae Lamrani Hanchi, Nabila Soraa
    Background and Objectives

    A new type of corona virus has caused Corona virus disease-19 and, subsequently, a global pandemic. All individuals are prone to the disease, so drastic measures were taken to prevent its spread. This study aimed to evaluate the impact of COVID-19 on the progression of the antimicrobial resistance rate by comparing two periods: before and during COVID-19.

    Materials and Methods

    We used a cross-sectional design to investigate the Antimicrobial Resistance (AMR) rate before (03/2019 to 03/2020) and during COVID-19 (03/2020 to 03/2021) in a University Hospital in Marrakech. The data were analyzed using SPSS Version 25.0.

    Results

    Among the 7106 specimens, there was a significant increase in the multidrug-resistant bacterial from 27.38% to 35.87% during COVID-19 (p<0.001), particularly in blood culture, cerebrospinal fluid, catheter, and pus. However, there was a non-significant change in puncture fluid, expectoration, protected distal sampling, joint fluid, stool culture, and genital sampling. A decrease in Multidrug-resistant bacteria (MDRB) was observed only in cytobacteriological urine tests (p<0.05). According to species, there was an increase in extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapen- em-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus.

    Conclusion

    In our study, it is particularly noticeable that the MDRB has increased. These results highlight the importance that the pandemic has not been able to slow the progression.

    Keywords: Multidrug resistant bacteria, Antimicrobial resistance, Rate, Corona virus disease-19, Microbiological profile}
  • Salman Daneshi, _ Saied Bokaie*, Alireza Bahonar, Ali Akbar Haghdoost, Eshagh Barfar, Cain C. T. Clark
    Introduction

    This study aimed to identify the effect of differences in age-sex structure in COVID-19 hospitalizations and death rates among men and women in Iran. Accordingly, we calculated the SARS-CoV-2 hospitalized patients and mortality rates, stratified by sex, age, and demographic distribution.

    Materials and Methods

    This was a cross-sectional study, where the target population was the total population from 20 March 2020 until 20 March 2022 in Iran, over the two-time periods, 20 March 2020 until 20 March 2021 [first year], and 20 March 2021 until 20 March 2022 [second year]. The chi-squared test was used for analysis.

    Results

    During the first year, 493220 cases were hospitalized with 258209 (52%) men, in addition 61,586 deaths occurred, where 34,849 [57%] were men. The overall hospitalization rate per 100,000 population in men and women was 607.77 and 565.57, respectively, and the mortality rate per 100,000 population in men and women was 82.03 and 64.34, respectively. During the second year, 652893 cases were hospitalized, where 340344 (52%) were women. The overall hospitalization rate per 100,000 population in men and women was 727.98 and 809.67, respectively, in addition to 54,740 deaths, where 29,172 [53%] were men. The overall mortality rate per 100,000 population in men and women was 67.95 and 60.83, respectively.

    Conclusion

    The findings showed a higher hospitalization in the first year in men, whilst the opposite was evident in the second year. The mortality rate increased with age and was most predominant in men, 50 years of age or older. Therefore, there is a need for policy makers to be acutely aware of the discrepancies in mortality according to age and sex groups, and have different, and complementary, strategies for controlling the pandemic by age and sex groups.

    Keywords: COVID-19, Hospitalization rate, Iran Mortality, Rate}
  • Gedeon Abayneh Mache, Hassen Mosa Halil *, Ritbano Ahmed Abdo
    Background & aim

    Caesarean delivery is a lifesaving surgical procedure for both the mother and the infant in specific medically indicated circumstances, but unnecessary caesarean delivery can lead to increased medical risks. This research considers the rate, indications and contributing factors of caesarean delivery in the Durame Hospital, Southern Ethiopia.

    Methods

    This hospital-based, cross-sectional study examined the period from May 1 through June 1, 2019. Three hundred respondents were enrolled by consecutive sampling, and a structured tool and document review were used for data collection. Data entry and analysis were conducted with EpiData (version 3.1) and SPSS software (version 24). Multivariable logistic regression was employed to determine the contributing factors associated with caesarean delivery at a 95% confidence interval (CI).

    Results

    The overall rate of caesarean delivery was observed to be 24.7%. Non reassuring fetal heart rate (n=13; 17.06%) and abnormal presentation (n=9; 12.2%) were the two most prevalent indications of cesarean delivery. The factors associated with cesarean delivery were previous cesarean delivery (AOR =7.3, 95 % CI: 2.02-26.65), post-term pregnancy (AOR=3.3, 95% CI: 1.268.67) and maternal age of ≥35 years (AOR=3.21, 95% CI: 1.19 -8.67).

    Conclusion

    The rate of caesarean delivery exceeded the recommended limit of the World Health Organization. To ensure the appropriate use of the procedure, women with a previous caesarean delivery must be meticulously evaluated for the possibility of vaginal delivery, and the hospital must regularly monitor caesarean delivery indications.

    Keywords: Cesarean delivery, Rate, Contributing Factors}
  • Sadegh Jafarzadeh, Akram Pourbakht *
    Background and Aim
    The auditory brainstem response (ABR) is one of the most common objective hearing tests conducting in animal and human. The purpose of this study was evaluating the morphology variations of ABR waveforms in rats with low and high rate click stimuli.
    Methods
    First, rats with ABR thresholds higher than 55 dB SPL were excluded and total 81 ears remained in study. Absolute and interpeak latencies of wave I, II, IV were evaluated at low (17.7 Hz) and high rate (88.7 Hz) for click stimuli at 120 dB SPL.
    Results
    At low rate stimuli, ABR waveforms showed different morphologies. The most common complex for waves II to IV was wave III placed on downward slope of wave II (71% of cases). Almost the same morphologies were seen at higher rate; but in some waves, it rounded and decreased amplitude. For waves IV-V, the most common morphology was equal amplitude of wave IV and V in low and high rates (35% vs 56%, respectively). Generally, the high rate stimuli didn’t severely change morphology patterns except for later waves.
    Conclusion
    Normal click-evoked ABR could result in different waveforms. Using click stimuli at low and high rate result in different morphology patterns. Recognizing morphology variations of ABR waveforms are essential for detecting any pathological conditions. The high rate stimuli increased latencies, especially for later waves.
    Keywords: Auditory brainstem response, rat, latency, morphology, rate}
  • حمیدرضا شتابی، شیوا کاظمی، ندا ایزدی، مژگان روحانی، شیما سادات خرمی، فریبا کریمی، مهنوش ایزدی
    مقدمه
    شاخص مرگ پری ناتال یک شاخص مهم بهداشتی و ارزیابی سلامت است که تاثیر مستقیم بر شاخص مرگ و میر شیرخواران دارد. هدف از انجام مطالعه حاضر، تعیین میزان و علل مرگ و میر پری ناتال در شهرستان کرمانشاه بود.
    روش ها
    در مطالعه مقطعی حاضر موارد ثبت شده مرگ و میر پری ناتال شهر کرمانشاه طی سال‏های 93-1390 استخراج شد. اطلاعات شامل مشخصات نوزاد، اطلاعات مربوط به مادر، شاخص های بارداری و زایمان و علت اصلی مرگ بر اساس International Classification of Diseases 10th (ICD-10) جمع آوری شد. اطلاعات با استفاده از میانگین و انحراف معیار برای متغیرهای کمی، تعداد و درصد برای متغیرهای کیفی و نرم افزار Stata تجزیه و تحلیل شد.
    یافته ها
    از 1236 مرگ پری ناتال، 1/56 درصد پسر بودند. بیشترین مرگ و میر در گروه وزنی، کم و بسیار کم و شایع ترین بیماری زمینه ای مادر، پرفشاری خون بود. بیشترین میزان مرگ پری ناتال مربوط به سال 91 (3/12 مرگ در هر هزار تولد) و کمترین میزان مربوط به سال 93 (7/5 مرگ در هر هزار تولد) بود. شایع ترین علت مرگ پری ناتال با 6/87 درصد مربوط به گروه اختلالات مشخص با منشا دوران پیرامون تولد بود.
    نتیجه گیری
    با توجه به نتایج، تاکید بر مراقبت‏های کافی در دوران حاملگی و پری ناتال، شناسایی و پیگیری دقیق تر مادران پرخطر و دارای بیماری های زمینه‏ای، پیشگیری از زایمان زودرس و تولد نوزادان دارای کم‏وزنی شدید می تواند در کاهش مرگ و میرهای پری ناتال موثر باشد.
    کلید واژگان: مرگ و میر پری ناتال, علت مرگ, ایران}
    Hamid Reza Shetabi, Shiva Kazemi, Neda Izadi, Mozhgan Rohani, Shima Khorami, Fariba Karimi, Mahnoosh Izadi
    Background
    Perinatal mortality indicator is a major indicator of health and health assessment that has a direct impact on infant mortality indicator. This study was aimed to determine the rate and causes of perinatal mortality in district of Kermanshah.
    Methods
    In this cross-sectional study, records of perinatal mortality in district of Kermanshah were extracted during 2011-14. Information, including the neonate, data about the mother and indicators of pregnancy and childbirth and the leading cause of death based on ICD-10 was collected. Data were analyzed using mean and standard deviation for quantitative variables and count and percent for qualitative variables by Stata ver.11 software.
    Findings: 56.1% of 1236 perinatal death was boy. Most mortality was in low and very low weight and most common underlying disease mother was hypertension. The highest perinatal mortality rate was in 2012 year (12.3 per thousand births) and the lowest in 2014 year (5.7 per thousand births). The most common cause of perinatal death by 87.6% was related to specific disorders originated around the time of birth.
    Conclusion
    According to the results, emphasizing adequate care during pregnancy and perinatal, more accurately identify and track high-risk women with underlying disease and the prevention of preterm birth and low birth weight babies can be effective in reduction of perinatal mortalities.
    Keywords: Rate, Mortality, Perinatal}
  • ندا ایزدی، حمیدرضا شتابی، سارا بختیاری *، مریم جنت المکان، مهوش پارابی، کوروش احمدی
    زمینه و هدف
    شاخص های بهداشتی نمایانگر سطح سلامت در جامعه می باشند و میزان مرگ و میر کودکان یکی از مهم ترین شاخص های بهداشتی، فرهنگی و اقتصادی هر جامعه است که در ارزیابی سلامت جامعه مورد توجه قرار می گیرد. این مطالعه با هدف تعیین میزان و علل مرگ و میر کودکان 59-1 ماهه بیمارستانی در استان کرمانشاه انجام گرفت.
    مواد و روش ها
    در این مطالعه مقطعی، موارد ثبت شده مرگ و میر کودکان 59-1 ماهه استان کرمانشاه طی سال های 93-1390 استخراج شد. اطلاعات شامل مشخصات دموگرافیک (سن، جنس متوفی، محل سکونت و شهرستان) و علت مرگ کودکان بر اساس دهمین طبقه بندی بین المللی بیماری ها (ICD-10) جمع آوری شد. موارد مرگ و میر کودکان در هر سال بر تعداد تولدها تقسیم شد. اطلاعات با استفاده از آمار توصیفی و آزمون مجذور کای تجزیه و تحلیل شد.
    یافته ها
    435 مرگ در بیمارستان های استان کرمانشاه ثبت شده بود. میانگین و انحراف معیار سن مرگ کودکان 99/13±33/13 ماه بود. بیشترین موارد مرگ مربوط به جنس پسر (9/54%) و از نظر محل سکونت، 78% (337 مورد) از افراد در شهر و بقیه در روستا بودند. بیشترین میزان مرگ مربوط به سال 1390 (6/3 مرگ در هر هزار تولد) و کمترین میزان مربوط به سال 1392 (5/2 مرگ در هر هزار تولد) بود. بیشترین علت مرگ کودکان مربوط به حوادث و سوانح (6/18%) و کمترین میزان علت منجر به مرگ مربوط به بیماری های سیستم ادراری- تناسلی بود (3%). بین جنسیت و محل سکونت با علل مرگ و میر کودکان ارتباط آماری معنی داری مشاهده نشد (05/0P>).
    نتیجه گیری
    با توجه به مهم ترین علل مرگ، طراحی مداخلات و آموزش والدین و کودکان در خصوص پیش گیری از سوانح و حوادث و بالا بردن آگاهی والدین در مورد علائم و نشانه های بیماری ها به ویژه بیماری های دستگاه تنفسی به منظور کاهش مرگ و میر کودکان، ضروری به نظر می رسد.
    کلید واژگان: میزان, مرگ و میر, کودکان 59, 1 ماهه, کرمانشاه}
    N. Izadi, H. R. Shetabi, S. Bakhtiari *, M. Janatalmakan, M. Parabi, K. Ahmadi
    Background and Objectives Health indicators reflect the health of the community and infant mortality rate is one of the most important indicators of health, economy and culture in each community that are taken into consideration in public health assessment. This study aimed to determine the rate and causes of mortality of children aged 1-59 month(s) in the hospitals of Kermanshah province.
    Method and Materials: In this cross-sectional study, the registered cases of mortality of children aged 1-59 month(s) during 2011-2014 in Kermanshah province were extracted Information included demographic characteristic (age, sex of the deceased, residence and county) and the children’s cause of death based on the tenth international classification of diseases (ICD-10) was collected. Child death cases in each year were divided by the number of births. Data were analyzed using descriptive statistics and chi- square test.
    Results
    Four hundred and thirty five deaths were recorded in the hospitals of Kermanshah province. The average age of children at death was 13.33 ± 13.99 months. Most death cases were related to boys (54.9 percent) and in terms of residence, 78% (337 cases) of people were in the city and the rest in the countryside. The highest mortality rate was in 2011 (3.6 deaths per thousand births) and the lowest in 2013 (2.5 deaths per thousand births). The most common cause of child death was related to injuries (18.6%) and the lowest cause of death was related to genitourinary system diseases (3%). The relation between gender and residence with the causes of infant mortality was not statistically significant (P>0.05).
    Conclusion
    According to the most important causes of death, designing interventions and educating parents and children about the prevention of injuries and raising parents awareness about the signs and symptoms of diseases, especially respiratory system diseases seem to be essential to reduce child mortality.
    Keywords: Rate, Mortality, Children aged 1, 59 month(s), Kermanshah}
  • Mohammad Mohseni, Mahtab Alikhani, Sogand Tourani, Saber Azami-Aghdash, Sanaz Royani, Mohammad Moradi-Joo
    Background
    Discharge against Medical Advice (DAMA) is a problem for hospitals which may result in increasing readmissions, morbidities, inabilities, deaths and health care costs. This study, aimed to investigate the rate and causes of DAMA in Iranian hospitals.
    Methods
    A systematic review and meta-analysis study was conducted in 2014. Required data were collected through searching for key words included: «Discharge Against Medical Advice», «Leaving against medical advice», «causes*», «hospital» and their Persian equivalents, over databases including PubMed, OVID, Google Scholar, Embase, Scopus, Magiran, scientific information database (SID). The reference lists of the articles, certain relevant journals and web sites in this field were also searched.
    Results
    Out of 913 articles initially retrieved, finally 17 articles were incorporated into the study. There were 244858 individuals studied in the articles. Using a random effects model, the rate of DAMA in Iranian hospitals was estimated at 7. 9% (6. 3%-9. 8%). While the highest rate of DAMA was associated with patients in departments of psychiatry (12%), the lowest rate was related to patients in departments of pediatrics (3. 7). DAMA was in men more than women (P<0. 05) Patient''s perception of feeling of wellbeing, financial problems, family problems, the lack of attention from physicians and nurses, inappropriate behavior with patients by hospital team and the lack of timely care were mentioned as main causes for DAMA.
    Conclusion
    The rate of DAMA in Iranian hospitals is relatively high. Thus effective initiatives in this area are required.
    Keywords: Rate, Causes, Discharge, Systematic review, Meta, analysis, Iran}
  • مهرانگیز جمشیدپور، ندا ایزدی *، فرید نجفی، فیروزه خاموشی، اکرم روستایی شیردل، کتایون جلیلی
    زمینه
    مرگ و میر مادر باردار از مهم ترین شاخص هایی است که نشان دهنده وضعیت توسعه کشورهاست. این مطالعه با هدف بررسی میزان و علل مرگ و میر مادر باردار در استان کرمانشاه انجام شد.
    روش ها
    در این مطالعه مقطعی اطلاعات ثبت شده مرگ و میر مادر باردار شامل مشخصات جمعیت شناختی، شاخص های مربوط به بارداری و زایمان و علت مرگ طی سال های 91-1380 از واحد بهداشت خانواده معاونت بهداشتی استان به طور سرشماری استخراج شد. برای تعیین میزان مرگ و میر، موارد مرگ و میر مادر باردار در هر سال بر تعداد تولدهای زنده تقسیم شد. اطلاعات با استفاده از نرم افزار Stata مورد تجزیه و تحلیل قرار گرفت.
    یافته ها
    میزان مرگ و میر مادر باردار در استان کرمانشاه 9/25 نفر در هر صدهزار تولد زنده بود. بیشترین و کمترین میزان مرگ به ترتیب در سال های 1382، 4/53 و 1391، 6/14 به دست آمد. بیشترین مادران متوفی در گروه سنی 35-18 سال (6/64%)، ساکن شهر (7/66%) و در گروه حاملگی پرخطر (3/65%) بودند. شایع ترین علت مرگ مادر، خونریزی (2/23%) بود. شایع ترین علت مرگ مادر در مناطق شهری عوارض مداخله های زایمانی و در مناطق روستایی خونریزی بود (008/0P=).
    نتیجه گیری
    میزان مرگ و میر مادران باردار در استان رو به کاهش است. هر چند شایع ترین علت مرگ مادر خونریزی است اما حاملگی های پرخطر نیز به عنوان یک عامل خطر مهم باید مورد توجه قرار گیرد.
    کلید واژگان: مرگ و میر مادر باردار, میزان, علل}
    Mehrangiz Jamshidpour, Neda Izadi*, Farid Najafi, Firouzeh Khamoshi, Akram Roustaei Shirdel, Katayoon Jalili
    Background
    Maternal mortality is one of the most important indicators that is indicative of the status of development of countries. This study was aimed to investigate the rate and causes of maternal mortality in Kermanshah province.
    Methods
    In this cross-sectional study, the maternal mortality records including demographic information, indicators of pregnancy and delivery, and mortality causes from 2001 to 2012 were extracted via census from the family health unit of the health deputy. To determine mortality rates, maternal deaths in every year were divided by the number of live births. Data were analyzed by Stata software.
    Results
    The maternal mortality rate in Kermanshah was 25.9 deaths per one hundred thousand live births. The highest rate was reported in 2003 (53.4) and the lowest rate in 2012 (14.6) per one hundred thousand live births. Most deceased mothers were urban residents (66.7%) with the age range of 18-35 years (64.6%), and high-risk pregnancies (65.3%). The most common cause of maternal death was bleeding (23.2%). There was a significant relationship between cause of death and urban-rural status, so that the most common causes in urban areas were complications of obstetric interventions whereas the most common cause in rural areas was bleeding (P= 0.008).
    Conclusion
    Based on the results, the mortality rate of pregnant mothers is declining in Kermanshsh. However, given the most common cause of death (bleeding) and high percentage of high-risk pregnancies, immediate and effective measures by healthcare personnel to prevent postpartum maternal mortality and adequate and appropriate care during pregnancy and after delivery are required to considered.
    Keywords: Maternal mortality, rate, causes}
  • حسن هاشمی، فرهاد رضوان، اکبر فتوحی، حمیدرضا گیلاسی، سهیلا عسگری، امیدعلی پاپی، رضا نوروزی راد، مهدی خبازخوب
    هدف
    تعیین روند میزان جراحی کاتاراکت طی سالهای 1386 تا 1390 در استان خراسان رضوی
    روش بررسی
    از مراکز جراحی کاتاراکت در استان خراسان رضوی بصورت تصادفی 5 مرکز انتخاب گردید، 3 مرکز ماژور (تعداد جراحی بیش از 3000 در سال) و 2 مرکز مینور بودند. از هر مرکز یک هفته در هر فصل بصورت تصادفی و در مجموع 20 هفته انتخاب و تعداد جراحی های کاتاراکت در این مدت محاسبه شد. به نسبت تعداد جراحی ها از هر هفته نیز درصدی از پرونده ها بصورت مفصل مورد آنالیز قرار گرفت.
    یافته ها
    تعداد کل جراحی های کاتاراکت انجام شده طی سالهای 1386 تا 1390 به ترتیب 21388، 22750، 23888، 28063 و 30100 تخمین زده می شود. میزان جراحی کاتاراکت با توجه به جمعیت استان خراسان رضوی بطور خطی در این مدت از 3782 (95% فاصله اطمینان از 3732 تا 3833) به 5021 (95% فاصله اطمینان از 4965 تا 5078) به ازای هر یک میلیون نفر می باشد. 0/3% از جراحی ها با روش اینتراکاپسولار، 15/1% با روش اکستراکپسولار، 845/6 با روش فیکوامولسیفیکاسیون و 0/1% با روش لنزکتومی بودند. طی 5 سال مورد مطالعه روش فیکو بطور معنی داری از 84/7% در سال 85 به 90/4% در سال 90 رسید در حالی که روش اکسترا از 14/7% به 9/2% طی این مدت کاهش داشت. 0/87% این جراحی ها دارای عارضه حین جراحی بودند.
    نتیجه گیری
    در این مطالعه برای اولین بار میزان جراحی کاتاراکت به طور اختصاصی در استان خراسان رضوی گزارش و مشخص گردید. میزان بدست آمده در مقایسه با مطالعه قبلی در ایران بطور قابل توجهی بهتر بوده و نسبت به معیار سازمان جهانی بهداشت قابل قبول و مطلوب می باشد. با توجه به رشد جمعیت مسن استان خراسان باید توجه کرد که برای پوشش کامل افراد نیازمند به جراحی کاتاراکت لازم است این میزان نسبت به وضعیت فعلی هنوز بالاتر باشد. لذا توجه به فراهم کردن تسهیلات جراحی کاتاراکت مخصوصا روش فیکوامولسیفیکاسیون و آموزش این روش می تواند جز اولویتهای نظام سلامت در این استان قرار گیرد.
    کلید واژگان: جراحی کاراکت, میزان, خراسان رضوی, روند}
    H. Hashemi, F. Rezvan, A. Fotouhi, H. Gilasi, S. Asgari, O. Papi, R. Norouzirad, M. Khabzkhoob
    Purpose
    To determine the trend of the cataract surgical rate in Khorasan Razavi Province between 2006 and 2010.
    Methods
    Five centers were randomly selected from the cataract surgery centers of Khorasan Razavi Province. Using the definition of more than 3000 cataract surgeries per year for a major center, 3 centers were major and 2 were minor. One week of each season was randomly selected for each center and the number of cataract surgeries in that particular week was calculated. A total of 20 weeks for each center were selected. Finally, a percentage of the records, proportionate to the number of surgeries per week, were thoroughly analyzed.
    Results
    The total number of cataract surgeries was estimated 21388, 22750, 23888, 28063, and 30100 from 2007 to 2011, respectively. The cataract surgical rate, considering the population of Khorasan Razavi province, increased linearly from 3782 (95% CI 3732-3833) in 2007 to 5021 (95% CI 4965-5078) in 2011 per 1,000,000 people. In addition, the types of surgeries were intracapsular, extracapsular, phacoemulsification, lensectomy in which were recorded as 0.3%, 15.1%, 84.56%, and 0.1% of the cases, respectively. During the five years of the study, phacoemulsification increased significantly from 74.7% in 2007 to 90.4% in 2011 while the extracapsular method decreased from 14.7% to 9.2% in the same period of time. About 0.87% of the surgeries developed intraoperative complications.
    Conclusion
    This study reported the cataract surgical rate in Khorasan Razavi province exclusively for the first time. The calculated rate was noticeably better than previous reports and was desirable and acceptable according to the WHO standards. However, with regard to the increase in the elderly population of the province, the rate should be even higher to cover all individuals requiring cataract surgery. Therefore, provision of the cataract surgery facilities, especially for the phacoemulsification, and education of this method should receive priority in the health system of this province.
    Keywords: Cataract surgical, Rate, Khorasan Razavi, Trend}
  • سارنگ یونسی *، محمد مهدی طاهری امین، پوراندخت سعادتی، سودابه جمالی
    مقدمه
    سندرم کلاین فلتر (47،XXY) یک اختلال آنوپلوییدی است که در مردان بروز می کند و فرد مبتلا دارای یک کروموزوم جنسی X اضافه است. این سندرم شایع ترین اختلال کروموزوم جنسی و دومین اختلال کروموزومی ناشی از افزایش یک کروموزوم (بعد از سندرم داون) است که شیوع آن از 1 به 500 تا 1 به 1000 در جوامع مختلف گزارش شده است و با افزایش سن مادر (مانند دیگر تریزومی ها) خطر بروز آن افزایش می یابد. تحقیق حاضر مطالعه ای گذشته نگر است که در مدت سه سال (از مرداد 1385 تا تیر 1388) بر روی 29100 زن باردار ایرانی که در سه ماهه دوم بارداری برای انجام تست های غربالگری سندرم داون مراجعه کرده بودند انجام شده است. زنان باردار مورد مطالعه، متعلق به 50 شهر از سراسر ایران بودند. در گزارش بسیاری از پژوهش های انجام شده آمده است که در اختلالات کروموزومی، از جمله سندرم کلاین فلتر، مارکرهای بیوشیمیایی سه ماهه دوم که برای غربالگری سندرم داون مورد استفاده قرار می گیرند، دچار اختلال می شوند. هدف از این مطالعه بررسی موارد سندرم کلاین فلتر یافته شده همراه غربالگری سندرم داون و بررسی تغییرات مارکرهای بیوشیمیایی و سونوگرافی در موارد جدا شده است.
    مواد و روش ها
    آزمایش کواد مارکر برای زنان باردار ارجاع شده به آزمایشگاه نیلو انجام و احتمال خطر سندرم داون برای جنین آنان تعیین شد. موارد اسکرین مثبت پس از تایید سن بارداری توسط پزشک معالج، برای انجام آمنیوسنتز به مراکز ژنتیک ارجاع شدند و همانند سایر بیماران، شش ماه پس از مراجعه به آزمایشگاه، برای پیگیری نتایج بارداری با آنان تماس گرفته شد. تعداد متولدین پسر 14751 و تعداد دختران متولد شده 14349 بود.
    نتایج
    در کل تست های انجام شده 7 مورد سندرم کلاین فلتر یافته شد. الگوی تغییرات مارکرها شبیه سندرم داون (افزایشhCG و DIA به همراه کاهش AFP و uE3) به دست آمد، با این تفاوت که کاهش AFP و uE3 کمتر از سندرم داون بود
    بحث و نتیجه گیری
    توجه به آمار متولدین سالهای 1385 تا 1388، نسبت جنسی (پسر به دختر) در این پژوهش (80/102) در مقایسه با کل جامعه (95/104) تفاوت معنی داری ندارد. مطالعه حاضر نشان می دهد که در سندرم کلاین فلتر، الگوی تغییرات پارامترهای بیوشیمیایی خون تا حدود زیادی شبیه الگوی تغییرات در سندرم داون می باشد، یعنی افزایشی در سطح hCG و Inhibin A دیده می شود در حالی که تغییرات AFP و uE3 کمتر و تقریبا نرمال است. با توجه به شیوع 1 به 1000، میزان انتظار بروز سندرم کلاین فلتر در متولدین پسر جمعیت مورد این مطالعه 7/14 نفر می باشد که 7 مورد با انجام تست های غربالگری تشخیص داده شد. بنابراین ضریب تشخیص (Detection Rate) 6/47% تعیین گردید. این یافته با گزارش Schmidt و همکارانش در هانوفر آلمان که در 1463 بیمار مورد مطالعه یک مورد سندرم کلاین فلتر با تست های غربالگری، تشخیص داده شد و ضریب تشخیص آنرا (با توجه به شیوع 1 به 600 سندرم کلاین فلتر در آلمان) 1/41% نشان داد، تفاوت معنی داری ندارد. در گزارش سونوگرافی، هیچ یک از 7 مورد فوق، یافته غیر طبیعی وجود نداشت که این یافته نیز با گزارش De Vigan C و همکارانش که در سال 2001 در پاریس انجام گردید، هم خوانی دارد.
    کلید واژگان: غربالگری, سندرم کلاین فلتر, ناهنجاری کروموزومی, تست غربالگری چهارگانه}
    Dr Sarang Younesi *, Dr Mohammad Mehdi Taheri Amin, Dr Porandoskht Saadati, Dr Soodabeh Jamali
    Backgruond: Klinefelter’s syndrome (47،XXY) is a chromosomal abnormality in which the affected male babies have an extra X chromosome. It is also the most common abnormality related to sex chromosomes and is the second chromosomal abnormality after the Down syndrome. It''s prevalence is 1 in 500 to 1 in 1000 in different populations. According to reports، the risk of Klinefelter''s syndrome is increased with increasing maternal age just like other chromosomal abnormalities. This retrospective study was performed in Nilou Medical Laboratory (Tehran، Iran) during the years 2006-2009. According to many reports maternal biochemical markers used for Down''s screenings are influenced in other chromosomal abnormalities such as Klinefelter''s syndrome، too. The aim of this study was to determine: how many fetuses were affected with klinefelter''s syndrome and how this abnormality influenced on maternal biochemical markers'' pattern (in quad screening tests).
    Methods
    For 29100 pregnant women (from 50 different cities) who referred to Nilou Medical Laboratory، the Quad screening test was performed and the risk for Down''s syndrome was calculated. Women with screening positive results، after their gestational age was confirmed by their physicians، were referred to genetic centers for amniocentesis. All those women were contacted 6 months later and asked about their pregnancy outcome and their baby gender and its health status. (out of 29100 babies born alive 14751 cases were boys and 14349 were girls).
    Findings
    7 babies out of 29100 had been diagnosed with Klinefelter’s syndrome (via amniocentesis). In those cases، maternal biochemical markers'' pattern was similar to the cases with Down syndrome (High hCG and inhibin A Moms، with low AFP and uE3 Moms). however; the decrease in AFP and uE3 Moms was not as much as with Down''s syndrome.
    Conclusion
    Regarding to the official birth consensus statements during the years (2006-2009، the sex ratio obtained in this study (102/80) showed no significant difference with the sex ratio in the whole population (104/95). This study showed that in mothers with an affected fetus with Klinefelter''s syndrome the biochemical markers'' pattern was similar to those whose fetuses are involved with Down syndrome (High hCG and Inhibin A Moms while the AFP and uE3 Moms are slightly low or near normal value). Regarding to the Klinefelter''s syndrome prevalence (1 in 1000)، it was expected that 14. 7 babies (male) would have been involved with this syndrome، among which 7 babies were diagnosed through amniocentesis (after maternal screening tests performed)، So the detection rate of our tests for klinefelter''s syndrome was 47. 6%. This figure shows no significant difference with those reported by Schmit et al (41. 1%) in Germany. Besides; none of the 7 cases with Klinefelter''s syndrome، had abnormal findings in their prenatal sonography reports at all. This finding also correlates with those by De Viga C et al (Paris، 2001).
    Keywords: Screening, Klinefelter's syndrome, chromosomal abnormality, Quad screening test, rate}
  • Tahereh Foroutan, Reza Amid, Mohammad Reza Karimi
    Introduction
    Periodontal diseases are considered as some of the most common reasons of teeth loss, which occur due to the aggregation of microbial plaque and other precipitations on the dental surfaces. In this study, the scaling effect using manual tools, ultrasonic machine and Erbium-Doped Yttrium Aluminum Garnet (Er:YAG)laser on the connection of the human gums connective tissue cells on the root surface of the teeth suffering from severe periodontitis will be compared.
    Methods
    After removal of the big precipitations with manual tools, Er:YAG laser light emission of Photona machine is used with respect to the following characteristics: wavelength: 2940μm, each pulse: 100mJ, frequency: 10 pulse/sec, optic fiber with cross section 0.5x1.65mm, fiber tip angle with root surface: 15-20 degrees with non-contact mode, 1.5mm farther than the root surface and pulse duration 230 very short. The gingival fibroblast cellular was incubated as a sample of the human gums connective tissue cells under 37C. These cells were departed from the culture medium after the cellular reproduction in the third passage.On the 3rd day after incubation, the gingival fibroblast cells morphology was studied by Scanning Electron Microscopy (SEM).
    Results
    The results of SEM images in the present study indicated the spread fibroblast cells with philopodia were found in all of 5 groups; untreated healthy group (control), untreated group suffering from periodontitis, the scaling effect using manual tools (Scaled Gracey), ultrasonic machine and Er:YAG laser. There is a meaningful difference among the three treatment groups (P<0.001) in the numbers of the fibroblast cells, while all the four treated groups had a meaningful difference with the positive control group (P < 0.001).
    Conclusion
    The present study indicated that although various dental surfaces cleaning methods may be different in other aspects, but are similar concerning the fibroblasts morphology. Also in addition to power, laser emission time may also be effective in the cells morphology results.
    Keywords: Er, YAG laser, periodontitis, rate, survival}
  • Seyyed Abolfazl Afjeh, Mohammad Kazem Sabzehei, Abdollah Karimi, Farideh Shiva, Ahmad Reza Shamshiri
    Background
    This study determined the incidence, characteristics, risk factors, and outcomes of ventilator-associated pneumonia (VAP) in newborns hospitalized in a Neonatal Intensive Care Unit (NICU) in Tehran, Iran.
    Methods
    A prospective cohort study was carried out in the NICU of Mahdieh Hospital over a period of one year, from December 2008 to November 2009, on all neonates mechanically ventilated for more than 48 hours. VAP was diagnosed in accordance with the CDC definition of nosocomial pneumonias for patients younger than 12 months. Risk factors relevant to the development of VAP were studied. Multiple logistic and Cox regression analysis were performed to determine independent predictors for VAP and survival rate, respectively.
    Results
    There were 81 neonates enrolled. VAP occurred in 14 (17.3%), at a rate of 11.6/1000 days on the ventilator. Gram negative bacteria were the predominant etiologic agents. The most common bacterial isolates from the endotracheal aspirate were E. coli (21.4%), Klebsiella (21.4%), and Pseudomonas (14.1%). The only VAP predictor was sputum [odds ratio (OR) = 5.11, P = 0.02]. Mortality rate for VAP was 2/14 (14.3%). Duration of mechanical ventilation [hazard ratio (HR) = 0.96, P = 0.01], birth weight (HR = 0.81, P < 0.001), and purulent tracheal aspirate (HR = 0.25, P < 0.006) were independent predictors of overall survival.
    Conclusions
    VAP occurs at a significant rate in mechanically ventilated newborns. Additional studies are needed to accurately determine the incidence and risk factors in order to develop effective preventive and therapeutic protocols.
    Keywords: Intensive care unit, neonate, rate, risk factors, ventilator, associated pneumonia}
نکته
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