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In July 2003, the Bellagio Study Group on Child Survival estimated that the lives of 6 million children could be saved each year if 23 proven interventions were universally available in the 42 countries re-sponsible for 90% of child deaths in 2000. The aim of this study was to determine frequency of important causes of mortality among under-5 year old children in hospitals, Tehran, Iran. Information about Mortality data of under-5 year old children from 16 hospitals in the West of Tehran was collected. The study period was conducted from 1 October 2005 to 30 March 2006. Educated health personnel in each hospital interviewed parents of children who died in hospital and filled out a checklist. 142 under-5 year old children died over the course of study, of whom, 118 (83%) were neonates (under 28 days-old), 53.5% had low birth weights (< 2500 Kg), 62 (43%) were girls and 80 (57%) boys. The most common cause of under-5 year death was due to certain conditions originating in the perinatal period (ICD-10: P00-P96) (68%). Congenital abnormalities (12%) and pneumonia (5%) were the second and third most common causes respectively. Among 28-day to one-year old children, the leading cause of death was pneumonia (27.3%), while for children being 1 to 5 years of age, this included pneumonia and chronic hepatitis (about 30%). Overall, the most common causes of death were disorders related to short gestation and low birth weight. Therefore, achievement of the millennium development goal of reducing child mortality by two-thirds from 1990 rate will depend on renewed efforts to prevent and control low birth weight, preterm delivery, pneumonia, and infectious diseases in our setting.

Surgery on the skeleton frequently requires harvesting of autogenous bone graft from the pelvis, but this procedure often is complicated by problems. The purpose of this retrospective, comparative descriptive study was to compare the efficacy of metal-derived bioactive glass (Novabone) versus autogenous iliac crest bone graft in adolescent idiopathic scoliosis surgery. The study was carried out on forty cases (aged 14-20 years) with 55 total curves fused for AIS. Posterior spinal fusion was performed using local bone grafts combined with autogenous iliac crest bone graft in 20 patients (group 1), and combined with Novabone in another twenty ones (group 2). The patients were observed for a minimum of 24 months after surgery, with a mean postoperative observation time of 34.7 months. The results were assessed clinically and radiologically. In group 1, average preoperative curve was 66° with immediate correction to 24.2° (59.7%) and final follow-up of 27.4° (54.3%), but in group 2 the calculated numbers included 63.8°, 25.8° (59.6%) and 28.4° (55.5 %) respectively. There were 5 indeterminate fusions (3 cases in group 1 and 2 in the other group), 1 acute infection, and 1 hook dislodgement in the synthetic group. These results justify and favor the use of bone substitutes for instrumented posterior spinal fusion in AIS. Potentially hazardous harvesting of pelvic bone is no longer necessary for such operations.

Objective: In this systematic review, we aimed to evaluate the existing strategies and interventions in domestic violence prevention to assess their effectiveness. Method: To select studies, Pubmed, ISI, CINAHL, PsycINFO, Cochrane, Scopus, Embase, Ovid, Science Direct, ProQuest, and Elsevier databases were searched. Two authors reviewed all papers using established inclusion/ exclusion criteria. Finally, 18 articles were selected and met the inclusion criteria for assessment. Following the Cochrane quality assessment tool and AHRQ Standards, the studies were classified for quality rating based on design and performance quality. Two authors separately reviewed the studies and categorized them as good, fair, and poor quality. Results: Most of the selected papers had fair- or poor-quality rating in terms of methodology quality. Different intervention methods had been used in these studies. Four studies focused on empowering women; 3, 4, and 2 studies were internet-based interventions, financial interventions, and relatively social interventions, respectively. Four interventions were also implemented in specific groups. All authors stated that interventions were effective. Conclusion: Intervention methods should be fully in line with the characteristics of the participants. Environmental and cultural conditions and the role of the cause of violence are important elements in choosing the type of intervention. Interventions are not superior to each other because of their different applications. [ABSTRACT FROM AUTHOR]

In acute lymphoblastic leukemia (ALL) patients treated with L-asparaginase, discontinuation of the drug occasionally occur due to severe drug complications or resistance, however, due to the high efficacy of this drug in the recovery of patients and the prevention of disease recurrence, resuming the drug regimen is preferred in most patients. What we did in this study was to evaluate and compare the effects of clinical outcomes in the two modes of continuing and discontinuing drug use. In this retrospective cohort study, all children with ALL who had been treated with L-asparaginase during the years 2005 to 2015 were included in the study and categorized into two groups receiving complete treatment regimen (n=160) and those who had to discontinue the drug due to appearing complications (n=9). The rate of relapse and mortality rate was determined and compared across the two groups with a median follow-up time of more than 5 years. 5-yrs Overall survival of all enrolled patients in the groups continued and discontinued was 91.4±2.5% and 71.4±17.1%, respectively (P=0.792). Also, 5-yrs event-free survival of the two groups was 75.8±3.5% and 71.4±17.1%, respectively (P=0.557. Relapse was revealed in 17.5% and 33.3% respectively and mortality in 16.9% and 0.0% (P=0.261). However, the overall prevalence of hypersensitivity reaction to the drug was significantly higher in those patients who discontinued their drug regimen (100% versus 24.4%, P<0.001). Hypersensitivity reaction to drugs may be an important factor in discontinuing L-asparaginase in patients with ALL. The discontinuation of L-asparaginase supplementation due to various complications such as hypersensitivity reactions may be effective in the survival of these patients. However, accurate determination of the effect of discontinuation of this drug on the outcome of children with ALL requires a more comprehensive study with more complicated cases. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to examine the association between ADHD and suicide attempts among adolescents with bipolar disorder. Method: Participants were 168 adolescents who fulfilled DSM-IV-TR criteria for bipolar disorder. They were divided into 2 groups: The first group of patients with bipolar disorder with a history of suicide attempts (n = 84) and the second group without a history of suicide attempts (n = 84). ADHD and other variables were analyzed using a chi-squared test and logistic regression model. Results: No significant difference was observed between the 2 groups in comorbidity of ADHD and other psychiatric disorders (P > 0/05). In the logistic regression model, and after controlling for other factors, gender (OR = 3.9, CI 95%: 1.5-9.6) and history of sexual abuse (OR = 3.4; CI 95%: 1.06-11.3) were the only 2 factors associated with a history of suicide attempts. Conclusion: No significant association was found between ADHD and suicide attempts in adolescents with bipolar disorder. [ABSTRACT FROM AUTHOR]

The aim of current study was to determine women´s maternal asthma in pregnancy, delivery and birth outcomes. Using a retrospective cohort design, data of 580 pregnant women were gathered form a large teaching hospital in Tehran, Iran. The medical records of pregnant women who had attended this hospital between 2009 and 2011 were assessed. Data of delivery and birth outcomes were gathered by observation and medical records of women. Multiple logistic regression and adjusted odds ratio (OR) were used to assess the independent association of asthma and outcomes. 274 patients (47.2%) were in "asthmatic group" and 306 patients (52.8%) were in the "non-asthmatic group". Basic and demographic variables showed the same distribution across two groups. Maternal asthma showed an adjusted relationship with gestational diabetes (OR=2.64), gestational hypertension (OR=3.79), cesarean delivery (OR=2.68), small for gestational age (OR=2.86), premature rupture of membrane (OR=2.18), preterm delivery (OR=1.74), abnormal vaginal bleeding (OR=3.75), and low birth weight (OR=1.78) significantly (p<0.05 for all associations). The majority of pregnancy, delivery and birth outcomes except fetal death, abortion, placenta previa and placenta abruption) were significantly associated with maternal asthma. The largest association of maternal asthma was with gestational hypertension and abnormal vaginal bleeding respectively. [ABSTRACT FROM AUTHOR]

Normal axial alignment restoration in lower extremities is crucial for surgeons performing reconstructive surgeries. Since reference normal values of axial alignment are affected by age, sex, and ethical issues, we tried to scrutinize these parameters in Iranian adults and compare them with normal values in literatures. Through a cross-sectional design, standing axial alignment views of lower extremities were surveyed from 100 volunteers (50 males and 50 females) aged between 15-32 years. The lower extremities alignment variables were evaluated during two separate measurements. Total average values were used for comparison among genders. Tibiofemoral mechanical angle depicted mean varus of 1.5 degrees in an Iranian population that was significantly higher in male participants. The Mean angle between anatomical and mechanical axes of the femur was 5.7 ± 1.2º. The Knee joint was shown to be medially inclined 3.6 ± 1.7º in men comparing 2 ± 2º of women with a significant difference. Joint line congruence angle was medially inclined in all of the study participants with a mean of 1 ± 1.6º. To compare with anthropometric studies of western populations, Iranian participants had more varus lower limb alignment. It seemed mainly because of larger medially inclined knee joint (knee-joint obliquity). This finding along with more compensatory ankle valgus is similar to results of other Asian studies. Such racial variation should be considered in designing appropriate systems in reconstructive surgery. [ABSTRACT FROM AUTHOR]

Background: Assessment of quality-of-life (QOF) as an outcome measure after deep brain stimulation (DBS) surgery in patients with Parkinson's disease (PD) need a valid, reliable and responsive instrument. The aim of the current study was to determine responsiveness of validated Persian version of PD questionnaire with 39- items (PDQ-39) after DBS surgery in patients with PD. Methods: Eleven patients with PD, who were candidate for DBS operation between May 2012 and June 2013 were assessed. PDQ-39 and short-form questionnaire with 36- items (SF-36) were used. To assess responsiveness of PDQ- 39 standardized response mean (SRM) was used. Results: Mean age was 51.8 (8.8) and all of the patients, but just one were male (10 patients). Mean duration of the disease was 8.7 (2.1) years. Eight patients were categorized as moderate using Hoehn and Yahr (H and Y) classification. All patients had a better H and Y score compared with the baseline evaluation (3.09 vs. 0.79). The amount of SRM was above 0.70 for all domains means a large responsiveness for PDQ-39. Conclusion: Persian version of PDQ-39 has an acceptable responsiveness and could be used to assess as an outcome measure to evaluate the effect of therapies on PD. [ABSTRACT FROM AUTHOR]

Background: Health assessment in patients with epilepsy (PWE) should include both clinical outcomes and health related quality of life (HRQOL) measures. The quality of life (QoL) in epilepsy-31 inventory (QOLIE-31) is widely used for QOL studies in epilepsy. This study aims to evaluate psychometrics of the Persian version of the inventory (QOLIE-31-P). Methods: Following a standard forward-backward translation and cultural adaptation, the construct validity of the QOLIE-31-P was assessed by explanatory factor analysis, multi-trait scaling analysis, and known group comparison. The criterion validity was assessed by calculating the Pearson correlation to SF-36 (36-item short-form health survey). The reliability was assessed by calculating Cronbach's alpha and test-retest study. Results: The factor analysis extracted from 8 factors explaining 70.35% of the variations. Item-scale correlations revealed that individual items significantly had the strongest association with the domain they were loaded on. The Pearson coefficient of correlation between QOLIE-31-P and the overall scores of SF-36 was 0.876 (P < 0.0001). Patient with medically controlled seizures scored higher than those who experienced seizures during the previous year to study date (P < 0.0001). The Cronbach's α of overall QOLIE-31-P inventory was 0.9. The overall test-retest coefficient of correlation was 0.68 (P = 0.003). Conclusion: QOLIE-31-P is a valid and reliable tool to be applied in health assessment of patients with epilepsy. [ABSTRACT FROM AUTHOR]

Coronary artery disease is one of the most common reasons of death around the world. Also, according to previous studies, the incidence of coronary artery disease is rapidly increasing in developing countries such as Iran. The aim of this study was to evaluate the knowledge and practice of pharmaceutical company workers towards the prevention of cardiovascular disease. In this cross sectional study that was conducted in Tehran, 1223 workers of a pharmaceutical company were enrolled. Data was collected using a questionnaire that assessed the level of knowledge and practice of the participants towards coronary artery disease. Regression analysis was used to evaluate the relationship between study variables and the workers knowledge level. The results of this study showed that 49% of the workers were in a good level of knowledge and according to the regression analysis, the female gender, age above 28, education level higher than high school diploma, body mass index above 25 kilograms per square meters, history of hyperlipidemia, history of diabetes, history of hypertension, history of myocardial infarction, daily activity and exercise, were significantly related to a good knowledge towards coronary artery disease. In addition, the mean score of the participants' performance in preventing coronary artery disease was 4.66 out of 9. The results of this study showed that increasing level of knowledge of labors in order to prevent missing specialized work force, leads to imposition of health costs to the industry and the labor society. [ABSTRACT FROM AUTHOR]

Objective: According to most studies, aspirin sensitivity is associated with asthma severity and occasionally poor response to inhaled corticosteroids. The aim of this study was to assess the prevalence of aspirin sensitivity in patients with moderate to severe asthma according to three months standard treatment response. Material and Methods: This randomized clinical trial is done on 18 to 65 years old patients with moderate to severe asthma who referred to the Department of Allergy and Clinical Immunology, Rasool Akram Hospital, since February 2015 to February 2016. To evaluate the patient's response to 3 months asthma standard therapy, prebronchodilator FEV1 values and Asthma Control Test (ACT) scores were assessed before and after the treatment. At the end, patients underwent the oral aspirin challenge test. Results: 65 patients were eligible for the oral aspirin challenge test. The average age of participants was 40.86 ± 11.53 years. 19 males (29.23%) and 46 females (70.77%) were participated. 27 (41.5%) patients were diagnosed with moderate asthma and 38(58.5%) with severe asthma. History reactions to aspirin or NSAID were positive in 18 (27.7%) subjects. The prevalence of aspirin sensitivity was 35.38% based on oral aspirin challenge test. Aspirin sensitivity was more prevalent in patients with moderate asthma (60.9%). Past history of reaction to aspirin or NSAID was significantly associated with positive aspirin challenge test. There were no statistical significant differences between aspirin sensitive and aspirin tolerant asthma in mean prebronchodilator FEV1 values and ACT scores before and after the treatment. Conclusion: According to this study aspirin sensitivity was not associated with poor response to standard treatment in patients with moderate or severe asthma. [ABSTRACT FROM AUTHOR]

Objective: Nasal Polyposis is a chronic and recurrent disease. Among patients with nasal polyposis 15% are aspirin sensitive. In parallel with increased disease severity, the prevalence of aspirin sensitivity increases. An oral aspirin challenge is necessary for Diagnosis. Aspirin challenge testing is difficult and time consuming, adverse reactions of aspirin are dose dependent and during aspirin challenge high doses of aspirin are administered, on the other hand aspirin desensitization is a specific treatment for patients with nasal polyposis and aspirin sensitivity. Therefore, it is necessary to find criteria to select patients with high probability of aspirin sensitivity for aspirin challenge testing. This study is done to compare aspirin sensitive and aspirin tolerant patients with nasal polyposis, according to response to standard treatment. SNOT22 scores were compared before and after treatment to evaluate response to treatment. Material and Methods: The diagnosis of nasal polyposis is made by CT scan. Patients were included in order, until the sample size was fulfilled. SNOT22 questionnaire was used for evaluation of severity of symptoms before and three months after standard treatment. Results: In this study, 78 patients (25 males and 53 females) with the average age of 41/56±11/74 years (18-63) were included. Aspirin challenge test was positive in 29 patients (37/2%). SNOT22 scores before treatment in aspirin sensitive and aspirin tolerant patients were 52/97±17/73 and 47/04±18/30 respectively and after treatment were 27/41±16/61 and 24/88±16/72 respectively which are not significant (p=0.518). Conclusion: There is no significant difference between two groups in SNOT22 scores before and after treatment. According to this study, the only factor that could predict aspirin sensitivity is the history of recurrent reactions to NSAIDs, especially to different kinds of NSAIDs. [ABSTRACT FROM AUTHOR]