مجله تحقیقات نظام سلامت حکیم
سال هشتم شماره 1 (پیاپی 28، بهار 1384)

TB is a major cause of morbidity and mortality around the world. Due to WHO report, 8.3 million new cases of TB had occurred in 2000 which 9% of them had TB/HIV co-infection.  

In this study we prospectively evaluated TB/HIV patients between 2001– 2003 in a referral center in Iran. Sputum smear and culture was conducted for all patients. In the case of positive culture antibiogram was performed. All blood samples were studied using flowcytometry. We analyzed clinical and laboratory data by SPSS for windows(version 11).  

Fifteen patients included in this study. Thirteen (86.7%) were male. Mean age was 36.9 ± 5.87. Intravenous addiction was the most common route of transmission (86.7%). Eighty percent of patients had history of prison. All patients had pulmonary TB. Two patients had also empyema and pericarditis. Thirteen (86.7%) were smear positive. Eighty percent had HCV co-infection. Mean CD4 count was 229.15 ± 199.45. All patients except one had atypical radiological presentation. Drug induced hepatitis occurred in 20% of patients and 5(33.3%) died. Approximately 78.6% of patients had CD4 count below 350.  

HIV patients had higher rate of mortality and drug induced hepatitis. TB may be AIDS- defining illness in Iran.

Hepatitis B is one of the most common viral infections worldwide. The prevalence of hepatitis B is 1.07-5% in Iran. It is necessary to know the common routes of transmission of hepatitis for prevention of the disease. In this study, we evaluate the risk factors of hepatitis B by comparing hepatitis B patients with healthy blood donors.  

We assessed 39598 volunteer blood donors referred to Ghazvin Blood Transfusion Organization for hepatitis B. Risk factors were obtained from 186 patients and 186 healthy donors who were randomly selected. Hepatitis B was diagnosed according to positive result of HBsAg test (ELISA method).  

Prevalence of HBV was 1.08%. Logistic regression analysis showed that only duration of marriage [P=0.01, OR=1.04(1.01-1.07)], contact with an icteric person [P<.0001, OR=23.62(5.32-104.93)], sexual contact with people other than their spouses [P=.03, OR=10.46(1.28-85.77)], genital infection [P=0007, OR=5.37(2.04-14.13)] and high risk jobs [P=.01, OR=2.2(1.2-4.1)] are independent risk factors for prediction of hepatitis B infection.  

Ghazvin is one of the low prevalent regions for hepatitis B in Iran. Prevalence of hepatitis B is decreasing in Iran in the last decades. Horizontal mode is more important than vertical transmission in this region of Iran. Screening programs, education and vaccination, specifically in these high risk groups is essential for prevention of new cases.

Giardia intestinalis is the most common intestinal protozoa in developing countries, including Iran. Treatment of infection by metronidazole has some difficulties because of long course of therapy (7-10 days) and various side effects. The objective of this study was to determine the efficacy and side effects of tinidazole compared with metronidazole in the treatment of G. intestinalis infection in children.  

In a randomized controlled clinical trial , 106 subjects ( 69 males, 37 females) with Giardia intestinalis infection were treated with tinidazole or metronidazole. Tinidazole 50 mg/kg single dose and metronidazole 15 mg/kg three times a day for 7 days were given orally to children. Parasitological cure was documented when there was 3 times negative stool examination for G. intestinalis at 1-2 weeks after therapy.  

Thirty seven of 42 individuals (88.1%) treated with tinidazole and 43 of 64 children (67.2%) treated with metronidazole had parasitological cure. Cure rate between two groups was significantly different (P<0.01). No major side effects were observed except two cases in metronidazole group who had mild headache and abdominal pain for two days and some had metal taste and three cases in tinidazole group had nausea, dizziness and headache.  

We conclude, tinidazole has a higher efficacy than metronidazole in the treatment of G. intestinalis infection and also has a few side effects. Because of single dose administration, short course of therapy and good compliance of patients, this preparation is preferred to metronidazole in the treatment of Giardia intestinalis infection.

Primary intracerebral hemorrhage (ICH) is less frequent than ischemic stroke, but with higher mortality rate in its acute phase. The aim of current study was to determine the mortality rate and to evaluate the influence of different factors on the mortality of patients with primary intracerebral hematoma.

This cross-sectional study performed on 121 patients admitted to Sina Hospital, because of primary ICH during 3 years, from 1999 through 2002.  

According to the study, 65% of patients were between 60-80 years of age and 68.3% of them had history of hypertension. The morality rate was 47.1%, most of them happened during the two first days of the event. Evacuation of hematoma was done for 28 patients, with mortality rate of 78% in comparison to 38.1% in those who received medical therapy. However, most of operation were performed on more severe ICH and all of operated patients did not have the same condition according to the operation set up.  

According to the study, low Level of consciousness, large volume of hematoma, extension of hematoma to ventricles, brain midline shift and hydrocephalus led to poor outcome. Age, sex, history of hypertension, diabetes mellitus, cigarette smoking and mean arterial pressure on admission had not significant effect on patients’ outcome. It seems that larger or case – control studies are necessary to declare the independent prognostic factors and benefit of surgery in ICH .

Human leukocyte antigens (HLA), because of associations between some HLA alleles and various disorders, are important in assessment of susceptibility to diseases. There are many studies showing that the most solid of such associations is between HLA-B27 and spondyloarthropathies particularly ankylosing spondylitis. The purpose of this study was to assess the association between HLA-B27 and ankylosing spondylitis in Iran, and finding the relative and absolute risk of ankylosing spondylitis with respect t HLA-B27 as well.  

Based on the studies done by others and recently by our group, the most valid technique in determining of HLA-B27 is polymerase chain reaction (PCR). The population under the study included 36 patients with ankylosing spondylitis and 30 of healthy volunteers. Allele specific PCR (using of complementary primers for specific sequences in exon-3 of HLA-B27 gene) used in PCR method. Estimations of relative and absolute risks of ankylosing spondylitis in presence of HLA-B27 antigen and also standard error of ratio for generalizing the result of present study to society were calculated.  

Finally, it was revealed that based on PCR method, 69.4% of patients under the study were HLA-B27 positive and relative risk of affecting by ankylosing spondylitis in HLA-B27 positives was 65 times morethan others.  

There are some differences among the results of such studies done in different races around the world. These differences may be due to many factors including variable geographical distribution of microbes or HLA-B27 subtypes.

 In the past, the main responsibility of blood transfusion services and hospital blood banks was to prepare blood and blood components sufficient to meet the needs of patients. Since 1985 by the discovery of HIV and the confirmation of its transmission through blood, the science of blood transfusion has changed into a specialized field called as “transfusion medicine”. The main goal of hospital transfusion committees is to review the use of blood and blood components and take measures to improve their appropriate use. The main aim of the present study is to consider the awareness of hospital managers about the role and quality of hospital transfusion committees and their activities.

 The study was descriptive and the population under study comprise of hospital managers. In this study first a questionaire was prepared by Iranian Blood Transfusion Organization (IBTO) experts given statistical consultation it included 23 questions addressing the awareness about the role of hospital blood transfusion committees. The questions were then sent to blood centers, through which hospitals would find access to. Out of 282 forwarded questionaires, 262 questions pertinent to 25 provinces were collected and analysed by SPSS version 10 using chi-square statistical method.

 Out of 262 hospital managers filling out the questionnaire, 89.4 percent had bachelor or upper degrees, 2.6 percent had diploma or higher certificates, and 7.6 percent did not specify their academic status. 82.8 percent of the hospitals in this study had transfusion committee on the other hand ,17.2 percent did not have any hospital transfusion committee and unfortunately 63.7 percent of the hospital managers did not have any formulated educational programs regarding the field of transfusion medicine in the educational curriculum of their hospitals. It is worth mentioning that 30 percent of the hospital managers held the belief that a person with high-risk behaviors could refer to blood centers as a blood donor and find out the results of the tests indicating whether he/she has developed infection markers such as AIDS or hepatitis.

 Based on the obtained results, IBTO in cooperation with Ministry of Health and Medical Education should indicat the necessity of the establishment of hospital transfusion committees. This could be done by implementing practical and educational methods through the cooperation of hospital managers and the relevant experts consequently the due attention would be cast upon the effective role of these committees. On the other hand, considering the significance of ensuring and promoting the safety of blood and blood components prepared in blood centers throughout the country, it is imperative to take measures to improve the relevant educational programs in medical universities so as to familiarize specialists, physicians, and paramedics with “transfusion medicine”.

Consumption of water contaminated with arsenic can cause different adverse health effects in humans. Therefore measurement of arsenic concentration in drinking water resources is necessary before implementation of any water supply projects and during operation and also for determination of any treatment processes efficiency.In this research we aimed to determine arsenic content of drinking water resources of some villages in Bijar city of Kurdistan province.  

For this purpose accuracy and precision of two field (Ez arsenic test kit) and laboratory silver diethyldithiocarbamate spectrophotometric method (SDDC) for measurement of arsenic in water was studied. Accuracy and precision of both methods was determined through analysis of synthetic distilled water containing specific concentration of arsenic. Then 44 villages was monitored and samples of polluted water was analyzed using SDDC.  

The results showed that both studied (field and laboratory) methods have high precision and accuracy for measurement of arsenic in drinking water. In the case of kit it is necessary to use 9.6 ml as sample volume. The field monitoring of 44 villages of Bijar showed that drinking water of 5 villages has high level of arsenic considering national drinking water standard for arsenic (50µg/L). The highest level of arsenic was observed in Gavandak equal to 422.5µg/L (8 times of national standard and 42 times of WHO guideline).  

Considering the widespread location of water sources in our country, it is recommended that Ez arsenic test kit could be used in the wide range of field monitoring activities. For accurate evaluations, SDDC method is preferred at reference laboratories considering advantages of mthod e.g speciation definition and independency to advanced instruments.

Angiogenesis is controlled by series of cellular interactions which are mediated by cell surface glycoconjugates terminal sugars. The aim of this study was to investigate the distribution and changes of the cell surface terminal sugars during hypothalamo– pituitary portal (HPP) system angiogenesis in rat embryos.  

In this study, 70 N-mary rat fetuses (10-20 gestational days) were used by lectin histochemichal technique as a tool to study distribution of the glycoconjugates and their changes during HPP system angiogenesis. All paraffin sections were incubated with different HRP- lectins from Vicica villosa (VVA), Glycine max (SBA) and Wistaria floribunda (WFA) specific for terminal sugars D-Gal, α, ß-D-GalNAc and D- GalNAc of complex glycoconjugates, respectively. On the basis of staining intensity, the sections were graded and nonparametric statistical test was used to compare differences between samples.  

The results demonstrated that some cells around Rathke’s pouch reacted with VVA from day 13 and increased to day 14 and then decreased afterward, significantly (P<0.05). Some cells around Rathke’s pouch reacted with SBA from day 14 to day 18 and then decreased afterward (P<0.05). Many cells around Rathke’s pouch reacted with WFA from day 13 and increased on days day 14 and day 15 (P<0.05), then decreased with developmental advancement.  

Our findings indicated that the distribution and changes of glycoconjugates with terminal sugars D-Gal, α, ß-D-GalNAc and D- GalNAc were regulated spatiotemporally and might play critical role (s) in cell interactions and tissue differentiations such as angiogenesis during embryonic development.