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Background: Communication technology development has provided easier and quicker services in various medical fields. One of the main applications of tele-communication is tele-education, which helps in remote education of students. This study was designed to compare impact of tele-education and regular education methods on anesthesiology residents.Methods and Materials: Anesthesiology residents participated in both tele-education and regular courses during a one-year period. Various related subjects were taught in tele conference and regular sessions. In each course, residents were assessed by pretest and posttest exams. Finally, satisfaction was evaluated regarding quality of sessions using questionnaires especially prepared for the purpose.Results: Mann-Whitney U test showed no statistically significant difference in pretest (p=0.15) and posttest (p=0.07) results of both courses, although this difference was notably in favor of tele- posttest results. The highest rate of satisfaction among residents was dedicated to "saving time" to get to tele conference classes. Moreover, 92.59% of residents preferred to take part in tele conference classes.Conclusion: The study showed that tele-education and regular methods could be equally effective in the education of residents. Some advantages of tele-education for anesthesiology residents were high satisfaction of residents, time saving, and overcoming long distance. Tele-education could be regarded as an effective substitute for regular education of anesthesiology residents. s.

Background: Despite various applications of tele-ICU, there are still many questions about its costs and advantages in ICU. Some of its advantages are accelerating consultations and bringing physicians’ satisfaction from tele-consultation outcomes. The aim of this study is to discuss these advantages. Materials and Methods: Initially a telemedicine network was implemented and in the case of having no related specialist, the physicians used telemedicine network to perform specialized tele-consultation to thoracic surgery ICU patients. ICU patient’s documents during a year before tele-consultation were studied and delay time in consultation was recorded and compared between the two phases. Finally, the physicians’ satisfaction with tele-consultation was evaluated. Results: Fifty-eight tele-consultations in various medical fields were carried out, of which 27 were neurology cases. From the time of receiving a consultation request to its performance, the mean time was 1.3 days in tele-consultation. Tele-consultations were given 2.5 times faster than face to face method. In evaluation of physicians’ satisfaction, 82.75% of them were fully satisfied from tele-consultation, 12.06% were partly satisfied and 5.17% were not satisfied. Conclusion: Since the length of hospitalization in ICU is crucial due to heavy costs of treatment, high risk of contamination and limited beds, performing timely consultation is a key factor in reducing hospitalization period. Tele-consultation in thoracic surgery ICU not only accelerates patient care, but also results in higher physician satisfaction.

Background: In recent years, electronic cigarettes (ECs) have been heavily advertised as an alternative smoking device as well as a possible cessation method. We aimed to review all published scientific literature pertaining to ECs and to present a simple conclusion about their effects for quitting smoking and respiratory health. Methods: This was a cross-sectional study with a search of PubMed, limited to English publications upto September 2014. The total number of papers which had ECs in its title and their conclusions positive or negative regarding ECs effects were computed. The number of negative papers was subtracted from the number of positive ones to make a score. Results: Of the 149 articles, 137 (91.9%) were accessible, of which 68 did not have inclusion criteria. In the 69 remaining articles, 24 studies supported ECs and 45 considered these to be harmful. Finally, based on this evidence, the score of ECs (computed result with positive minus negative) was −21. Conclusion: Evidence to suggest that ECs may be effective and advisable for quitting smoking or a safe alternative for smoking is lacking and may instead harm the respiratory system. However, further studies are needed.

We conducted in-depth interviews with key tobacco control policy-makers to explore their views and opinions of trends in tobacco use and the effectiveness of tobacco control programmes over the past 3 decades. A qualitative interview study was conducted in 2014 using a grounded theory approach. In-depth interviews were conducted with 86 key tobacco control policy-makers and data collection was based on principles of saturation. The core code "tobacco consumption and its control programme" was extracted and its related themes were listed. After review and classification by an expert panel, 9 categorized codes emerged. The final 31 codes were ordered according to their conceptual differentiations. Overall, tobacco consumption was constant over the past 3 decades; however it was increasing in females and young people and decreasing in older people; hookah consumption was increasing. A positive outcome is that tobacco use is now viewed negatively in the Islamic Republic of Iran, largely due to tobacco control programmes but the current situation is still not ideal and a comprehensive tobacco control law is needed.دراسة كيفية عن اتجاه استهلاك التبغ وبرامج مكافحة استهلاك التبغ خلال 30 عاماً في جمهورية إيران الإسلامية.غلام رضا حيدري، آرزو ابن احمدي، هري ا. لندو، فهيمه شامياني، محمد رضا مسجدي، محمد بهكام شادمهر، ليدا فدائي زاده.لقد أجرينا مقابات معمَّقة مع الواضعن الرئيسيين لسياسات مكافحة استهلاك التبغ لاستكشاف وجهات نظرهم وآرائهم عن اتجاهات استهلاك التبغ وفعالية برامج مكافحة استهلاك التبغ خال العقود الثلاثة الماضية. وأجريت دراسة كيفية عن طريق المقابات في عام 2014 باتباع طريقة النظرية المتأصلة. فأجريت مقابات معمَّقة مع 86 من الواضعن الرئيسيين لسياسات مكافحة استهلاك التبغ، واستند جمع البيانات إلى مبادئ التشبع. واستُخرج الرمز الأساسي "استهلاك التبغ وبرنامج مكافحته"، ثم سُدت المواضيع ذات الصلة. وبعد مراجعتها وتصنيفها من قبل لجنة خراء ظهرت 9 رموز لاحقة مصنفة ضمن فئات. ورُتبت الرموز ال 31 الأخرة وفقاً للتفاضات المفهومية. بالإجمال، كان استهلاك التبغ ثابتاً عى مدى العقود الثلاثة الماضية، غر أنه كان يتزايد لدى الإناث والشباب ويتناقص لدى كبار السن، واستهلاك الشيشة كان في ازدياد. إن إحدى النتائج الإيجابية هي أن استهلاك التبغ يُنظر إليه – الآن – سلبياً في جمهورية إيران الإسامية، ويرجع ذلك – بدرجة كبرة - إلى برامج مكافحة إستهلاك التبغ، ولكن الوضع الحالي لا يزال بعيداً عن المثالية، وهناك حاجة إلى وضع قانون شامل لمكافحة إستهلاك التبغ.Étude qualitative de l’évolution du tabagisme et des programmes de lutte antitabac sur 30 ans en République islamique d’Iran.Nous avons mené des entretiens approfondis auprès de responsables politiques clés de la lutte antitabac afin d’examiner leurs vues et opinions sur les tendances du tabagisme et sur l’efficacité des programmes de lutte antitabac au cours des trois dernières décennies. Une étude qualitative par entretiens a été conduite en 2014 suivant la méthodologie dite de la théorie à base empirique. Des entretiens approfondis ont été menés auprès de 86 responsables politiques clés de la lutte antitabac, et la collecte des données a reposé sur le principe de saturation. Le code source « consommation de tabac et programmes de lutte antitabac » a été extrait et les thèmes apparentés ont ensuite été listés. Après examen et classification par un groupe d’experts, neuf codes catégorisés ont émergé ultérieurement. Les 31 codes finaux ont été ordonnés en fonction de leurs différenciations conceptuelles. Dans l’ensemble, le tabagisme est resté constant au cours des 30 dernières années ; mais il a augmenté chez les femmes et les jeunes, a baissé chez les personnes âgées, et la consommation de houka a connu une augmentation. L’un des résultats positifs est que le tabagisme est à présent perçu négativement en République islamique d’Iran, en grande partie grâce aux programmes de lutte antitabac. Mais la situation actuelle est loin d’être idéale et l’adoption d’une législation antitabac complète est nécessaire.دراسة كيفية عن اتجاه استهلاك التبغ وبرامج مكافحة استهلاك التبغ خلال 30 عاماً في جمهورية إيران الإسلامية.غلام رضا حيدري، آرزو ابن احمدي، هري ا. لندو، فهيمه شامياني، محمد رضا مسجدي، محمد بهكام شادمهر، ليدا فدائي زاده.لقد أجرينا مقابات معمَّقة مع الواضعن الرئيسيين لسياسات مكافحة استهلاك التبغ لاستكشاف وجهات نظرهم وآرائهم عن اتجاهات استهلاك التبغ وفعالية برامج مكافحة استهلاك التبغ خال العقود الثلاثة الماضية. وأجريت دراسة كيفية عن طريق المقابات في عام 2014 باتباع طريقة النظرية المتأصلة. فأجريت مقابات معمَّقة مع 86 من الواضعن الرئيسيين لسياسات مكافحة استهلاك التبغ، واستند جمع البيانات إلى مبادئ التشبع. واستُخرج الرمز الأساسي "استهلاك التبغ وبرنامج مكافحته"، ثم سُدت المواضيع ذات الصلة. وبعد مراجعتها وتصنيفها من قبل لجنة خراء ظهرت 9 رموز لاحقة مصنفة ضمن فئات. ورُتبت الرموز ال 31 الأخرة وفقاً للتفاضات المفهومية. بالإجمال، كان استهلاك التبغ ثابتاً عى مدى العقود الثلاثة الماضية، غر أنه كان يتزايد لدى الإناث والشباب ويتناقص لدى كبار السن، واستهلاك الشيشة كان في ازدياد. إن إحدى النتائج الإيجابية هي أن استهلاك التبغ يُنظر إليه – الآن – سلبياً في جمهورية إيران الإسامية، ويرجع ذلك – بدرجة كبرة - إلى برامج مكافحة إستهلاك التبغ، ولكن الوضع الحالي لا يزال بعيداً عن المثالية، وهناك حاجة إلى وضع قانون شامل لمكافحة إستهلاك التبغ.Étude qualitative de l’évolution du tabagisme et des programmes de lutte antitabac sur 30 ans en République islamique d’Iran.Nous avons mené des entretiens approfondis auprès de responsables politiques clés de la lutte antitabac afin d’examiner leurs vues et opinions sur les tendances du tabagisme et sur l’efficacité des programmes de lutte antitabac au cours des trois dernières décennies. Une étude qualitative par entretiens a été conduite en 2014 suivant la méthodologie dite de la théorie à base empirique. Des entretiens approfondis ont été menés auprès de 86 responsables politiques clés de la lutte antitabac, et la collecte des données a reposé sur le principe de saturation. Le code source « consommation de tabac et programmes de lutte antitabac » a été extrait et les thèmes apparentés ont ensuite été listés. Après examen et classification par un groupe d’experts, neuf codes catégorisés ont émergé ultérieurement. Les 31 codes finaux ont été ordonnés en fonction de leurs différenciations conceptuelles. Dans l’ensemble, le tabagisme est resté constant au cours des 30 dernières années ; mais il a augmenté chez les femmes et les jeunes, a baissé chez les personnes âgées, et la consommation de houka a connu une augmentation. L’un des résultats positifs est que le tabagisme est à présent perçu négativement en République islamique d’Iran, en grande partie grâce aux programmes de lutte antitabac. Mais la situation actuelle est loin d’être idéale et l’adoption d’une législation antitabac complète est nécessaire.

OBJECTIVES: High-frequency jet ventilation (HFJV) is a convenient method for providing ventilation during fberoptic bronchoscopy. We describe an incipient approach of high-frequency jet ventilation via the working channel of a flexible bronchoscope for nonintubated patients who suffer from hypoxemia during bronchoscopy. The aim of this study was to test the effcacy of this incipient approach and determine the possible complications related to it. MATERIALS AND METHODS: Sixteen patients who had oxygen saturation below 70% that did not resolve with nasal oxygen for 20 s during interventional bronchoscopy were included in the study. High-frequency jet ventilation was administrated via the working channel of a bronchoscope for 3 min. Arterial blood gas circumscriptions were compared before and after jet ventilation. RESULTS: Oxygen saturation increased to >90% in all patients 30 s after jet ventilation. Mean arterial oxygen saturation pressure increased from 54.84 to 111.98 mmHg with jet ventilation (p=0.0001). Arterial carbon dioxide tension decreased after jet ventilation. The body mass index had no consequential effect on arterial carbon dioxide pressure after jet ventilation in our patients (p=0.1). Complications such as pneumothorax and working channel damage were not observed. CONCLUSION: High-frequency jet ventilation via the working channel of the bronchoscope is a novel method that can provide optimal ventilation with minimal complications to nonintubated patients suffering from hypoxemia during bronchoscopy. This method also reduces the duration of bronchoscopy procedures.

Telemedicine is useful in monitoring patients, and in particular those, such as lung transplant recipients, suffering from chronic illnesses. This prospective cohort study was conducted on 15 lung transplant recipients. The patients provided physicians with data from spirometry as well as their clinical respiratory symptoms via SMS messages. In cases where spirometry results or clinical symptoms required follow-up, the monitoring physician contacted the patient according to guidelines and gave appropriate instructions. Qualitative assessment of satisfaction showed that the sense of increased support from medical staff was rated highest (92.9%). Telespirometry is an efficient method of monitoring lung transplant recipients which leads to patient satisfaction, compliance, adherence to study and sense of security. Nevertheless, for optimal implementation of this method, thorough training of both medical staff and patients is required.

Background: Interventional bronchoscopic procedures are novel diagnostic and therapeutic methods in pulmonology, which may be unpleasant and dangerous to the patients; therefore, sedation and in some cases general anaesthesia are recommended. But adjusting the level of sedation is a challenge. In this study we intended to define a range of bispectral index (BIS) score suitable for these procedures. Materials and Methods: All patients referred to our interventional bronchoscopy unit were enrolled in the study. Sedation was induced using midazolam, sufentanil, and propofol with the patient breathing spontaneously. The target level of sedation was to reach a Ramsay sedation score of 3 and patient tolerance in performing the procedure. The BIS score was recorded at baseline and every five minutes thereafter. Correlation between different BIS values, propofol dosage, duration of procedure, and awakening time was evaluated. Results: A total of 70 patients were enrolled in this study with a mean age of 50± 16 years and 34 (48.6%) of them were males. The mean baseline BIS was 96±3.7, and the mean time to reach “stable BIS” (“stable time”) was 7.9±6 minutes. The mean “stable BIS” was 52±13.5 and 70% of patients had stable BIS between 40 and 60. Conclusion: BIS is a useful objective tool for evaluation of sedation, which can guide us through bronchoscopy and related procedures. According to our observational study, reaching the mean BIS level of 52±13.5 is required to prevent complications and ensure feasibility of the procedure.

Interventional bronchoscopy procedures are novel and effective modes of diagnosing and treating airway lesions. Airway management and ventilation are a major concern, especially when considering the fire hazard of ventilating during endobronchial thermal therapies. The aim of this study was to evaluate the usage of laryngeal mask airway (LMA) compared to rigid bronchoscopy for the ventilation of patients undergoing diagnostic or therapeutic interventional bronchoscopy procedures.During this prospective randomised clinical trial study, patients were randomly allocated to two groups for ventilation: LMA and rigid bronchoscopy. Vital signs, including blood pressure, heart rate and percentage of blood O2 saturation before and during the procedure, degree of sore throat after recovery and physician's satisfaction, were recorded.A total of 83 patients, including 45 in the "LMA" and 38 in the "rigid" groups, were enrolled in this study. Their mean age was 51±17 years, and 59 (71%) were male. There was a statically significant difference between "rigid" and "LMA" categories regarding the decrease in O2 during the procedure in proportion to baseline figures (p=0.028). Haemodynamic parameters were better maintained using LMA compared to rigid bronchoscopy.Laryngeal mask ventilation maintains better oxygenation and haemodynamic stability and ensures physicians' and patients' satisfaction regarding ease of use, airway access and fewer complications compared to rigid bronchoscopy. Therefore, LMA can be introduced as a reliable alternative for ventilation during interventional airway procedures.

Background/purpose Nowadays, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scoring systems have drawn much attention for the evaluation and prediction of disease process in patients admitted to intensive care units (ICUs). To use these scoring tools, their predicting power must be initially validated for the target patients. This study was conducted to evaluate the performance of these two scoring systems in an ICU for respiratory diseases in Iran. Material and methods All records of patients admitted during a 1-year period were retrospectively reviewed, and the APACHE II and SAPS II scores were calculated accordingly. Information gathering was performed using a questionnaire. Results A total of 415 records were used. The mean age of patients was 49.28 ± 0.94 years. Using receiver operating-characteristic curve, cutoff points for 80% sensitivity and specificity of mortality prediction for APACHE and SAPS scores were 13.5 and 27.5, respectively. Calibration and discrimination studies indicated an acceptable status for both scales, but APACHE II scoring system seemed to show rewarding outcomes. Conclusion Results indicate that APACHE II scoring system can be considered as a reliable method for predicting mortality in our referral respiratory ICU.

Background: One of the core responsibilities of health system is to treat tobacco dependence. This treatment includes different methods such as simple medical consultation, medication, and telephone counseling. To assess physicians′ opinions towards quality and result of different quit smoking methods provided in tobacco cessation services centers in Iran. Methods: In this cross-sectional and descriptive study, random sampling of all quit centers at country level was used to obtain a representative sample size of 100 physicians. Physicians completed a self-administered questionnaire which contained 10 questions regarding the quality, cost, effect, side effects, and the results of quitting methods using a 5-point Likert-type scale. Percentages, frequencies, mean, T-test, and variance analyses were computed for all study variables. Results: Most experts preferred to use combination quit smoking methods and then Nicotine Replacement Therapy (NRT) with 26 and 23, respectively. The least used methods were quit line and some methods without medication with 3 cases. The method which gained the maximum scores were telephone consultation, acupuncture, Willpower, Champix, combined method, and Interactive Voice Response (IVR) with the mean of 23.3, 23, 22.5, 22, 21.7 and 21.3, respectively. The minimum scores were related to e-cigarette, some methods without medication, and non-NRT medication with the mean of 12.3, 15.8 and 16.2, respectively. There were no significant differences in the mean of scores based on different cities (P = 0.256). Analysis of variance in mean scores showed significant differences in the means scores of different methods (P < 0.000). Conclusions: According to physicians acupuncture, personal methods and Champix are the most effective methods and these methods could be much more feasible and cost effective than other methods.

This study was conducted to quantify the implementation of the MPOWER policies and to assess any possible changes across Eastern Mediterranean Region (EMR) countries. In this comparative cross-sectional study based on 10 categories mentioned in MPOWER report 2015 a checklist was designed. Seven questions were scored from 0-4 and three from 0-3. The 22 EMR countries were ranked and compared by their total score on a scale of 0-37. The highest scores were achieved by Egypt and the Islamic Republic of Iran. Pakistan, Sudan and Yemen showed progress, while Bahrain, Jordan, Kuwait, Oman, and the Syrian Arab Republic had decreased scores. The total score of the EMR countries had decreased compared to 2013. Thus, there remains a need for greater focus on tobacco taxation and smoke-free policies to address this retrograde step.الدراسة الثالثة لمبادرة منظمة الصحة العالمية المتعلقة بمكافحة التبغ في بلدان إقليم شرق المتوسط عام 2011-2015.غلام رضا حيدري، آرزو ابن احمدي، هاري لندو، فهيمه شامياني، محمد رضا مسجدي، محمد شادمهر، ليدا فدائي زاده.أجريت هذه الدراسة لتحديد تنفيذ سياسات المبادرة وتقييم أي تغيرات محتملة في مختلف بلدان إقليم شرق المتوسط خال السنتين الماضيتن. وأُعدت قائمة مرجعية في إطار هذه الدراسة المقطعية المقارنة استناداً إلى 10 فئات مذكورة في تقرير 2013/15. وأعطيت درجات من 0 إلى 4 لسبع أسئلة ومن 0 إلى 3 لثاث أسئلة. وصُنّفت بلدان إقليم شرق المتوسط البالغ عددها 22 بلداً وقورنت بمجموع درجاتها عى مقياس من 0 إلى 37. وحققت جمهورية إيران الإسامية ومر أعى الدرجات. وأظهرت باكستان واليمن والسودان تقدماً، في حن تراجعت درجات كل من البحرين والأردن وعان والكويت والجمهورية العربية السورية. أن الدرجة الإجمالية لبلدان إقليم شرق المتوسط انخفضت مقارنة بعام 2013. وبالتالي، لا يزال ثمة حاجة لزيادة التركيز عى سياسات الضرائب عى التبغ وسياسات منع التدخن لمواجهة هذه الخطوة العكسية.Troisième étude sur les scores MPOWER OMS en matière de lutte antitabac dans les pays de la Région de la Méditerranée orientale durant la période 2011-2015.La présente étude a été conduite pour quantifier la mise en oeuvre des politiques MPOWER et évaluer les changements éventuellement survenus dans les pays de la Région de la Méditerranée orientale entre 2013 et 2015. Dans la présente étude transversale comparative basée sur 10 catégories mentionnées dans le rapport MPOWER de l’année 2015, une liste de contrôle a été mise au point. Sept questions ont été notées sur une échelle de 0 à 4 et trois questions sur une échelle de 0 à 3. Les 22 pays de la Région de la Méditerranée orientale ont été classés et comparés selon leurs scores totaux sur une échelle de 0 à 37. Les scores les plus élevés ont été obtenus par l’Égypte et la République islamique d’Iran. Le Pakistan, le Soudan et le Yémen ont montré des progrès, alors que Bahreïn, la Jordanie, le Koweït, Oman et la République arabe syrienne ont obtenu des scores inférieurs par rapport aux études précédentes. Les scores totaux des pays de la Région de la Méditerranée orientale ont baissé par rapport à l’étude de 2013. Il est donc nécessaire d’accorder une plus grande importance aux taxes sur le tabac et aux politiques sans tabac pour faire face à cette régression.

Following MPOWER's 2011 report, a study was conducted to quantify the implementation of MPOWER tobacco control policies in the Eastern Mediterranean Region (EMR) in 2013 to assess any possible change during the last two years. In this cross sectional study, based on 10 categories mentioned in MPOWER 2013, a checklist was designed and its scoring was agreed upon by Iranian and international tobacco control specialists. Seven questions were scored from 0 - 4 and 3 from 0 - 3. The 22 countries were ranked by their total score on a scale of 0 to 37. Among the 22 countries in the EMR, Iran, Kuwait, Egypt, Lebanon, Gaza and West bank and Jordan were scored 31, 28, 28, 26, 25 and 25 respectively. 14 countries scored more than 50%, a small improvement; 5 countries have seen their scores fall, and three countries received the same score as last time. The highest overall improvement was attributed to the warning label, and the sharpest decline was observed in the consumption category.There has been a slight overall improvement in tobacco control planning, although the desired levels have yet to be reached and some countries in the region have fared worse.

Evidence from the USA and elsewhere has linked smoking depictions in movies with youth smoking initiation. Prior research has not focused on depictions in films produced in the Middle East, however.We reviewed the 10 most commercially successful Iranian films released each year over three decades (1982-2011) to determine trends in depictions of tobacco use over time.Each movie was reviewed in its entirety, and depictions of smoking were recorded and classified as direct (characters holding or using tobacco products) and indirect (tobacco products appearing in the frame, but not being used). Time trends in average duration of direct, indirect and total smoking depictions were analysed using linear regression and Cohen's κ coefficient.The mean duration of tobacco depictions in the most commercially successful Iranian films fluctuated yearly over the 3 decades, but with an overall significant upward trend (p0.005). The proportion of movies depicting tobacco consumption during the three decades was 36% (1982-1991), 60% (1992-2001) and 74% (2002-2011), respectively. The average proportion of total movie time for these depictions (0.75%, 1.41%, 2.08%) increased significantly (p0.005) over the 3 decades as did the average duration of smoking depictions,(39.1, 67 and 99.3 s, respectively, p0.005).The significant increase in the proportion of movies depicting tobacco consumption and in the duration of smoking depictions over the past 30 years underscores the need for increased regulation of the Iranian film industry to minimise this important source of influence on tobacco initiation in young people.

One in every 10 cigarettes might be illicit, and these products are more common in low-income than in high-income countries.1 Iran and Iraq are the two main target markets for tobacco smuggling in the Eastern Mediterranean Region.2 A small survey in Tehran, in 2005, showed that 40% of smokers used illicit cigarettes.3 Another study, in 2009, revealed that 20.9% of smokers in Tehran consumed illicit cigarettes.4 Since 2009, new health warnings and holograms have been introduced on cigarette packs in Iran. In addition, the retail of cigarettes has been controlled5 and street selling forbidden.6 ,7 We designed this study to assess trends in the illicit cigarette trade in Tehran. A cross-sectional study of 2130 smokers aged 15 years and over who reported …

Bronchoscopic interventional procedures are novel means of treating airway lesions which are less invasive and well tolerated for patients with endo-luminal lesions, but managing the airway and oxygenating the patient in a field that is shared by both anesthesiologist and bronchoscopist is a major concern. Also in cases with subglottic and upper tracheal stenotic lesions an airway device placed inside the lumen interferes with the procedure and occasionally bears the hazard of ignition. Therefore, an airway device placing above the glottis with effective oxygenation is required. Laryngeal mask airway is a supra-glottic device which facilitates assisted or spontaneous positive pressure ventilation.In this study, eight patients with subglottic stenoses due to different etiologies are presented who underwent fiberoptic bronchoscopy and therapeutic interventions through laryngeal mask.In all these patients, we experienced simple access to the vocal cord, glottis and trachea and also the lesion, besides effective oxygenation of the patient. Furthermore, bronchoscopist and patients were both comfortable with the procedures.Laryngeal mask airway could be regarded as a reliable alternative for airway management during interventional bronchoscopic procedures, especially when they are located near the glottis or in the upper third of the trachea.

We report our initial experience with a heart-lung transplant operation performed on a 12- year- old girl with Eisenmenger syndrome at Masih Daneshvari Teaching Hospital in Tehran, in 2009. We also outline the operative indications, anesthetic management, and postoperative complications of heart-lung transplantation. We hope that this issue on transplantation may provide an encouraging prospect for patients with end-stage cardiopulmonary disorders in Iran.

Several pain assessment tools have been proposed for use in different settings, but neither have been validated for all patients, especially Iranians. We conducted this study to compare the accuracy of two most commonly used tools for evaluation of pain intensity in a group of postoperative Iranian patients. All postoperative patients admitted to the surgical wards of Masih Daneshvari and Rasoul Akram Hospitals, Tehran, Iran were studied. During a two-month period, patients were evaluated for pain intensity within 24 hours of operation. Visual analogue scale and faces rating scale were used for this purpose. Eighty-two patients were enrolled into the study. Forty-eight patients underwent obstetrics and 34 had general surgeries. Using Spearman analysis, we found a linear correlation between the results of the two methods (P=0.952). Using multivariate analysis, we found that none of the variables such as age, gender, and education level had significant effects on correlation between visual analogue scale and faces rating scale. Visual analogue scale and faces rating scale are two pain assessment tools that can be used interchangeably for evaluation of acute postoperative pain.

This descriptive study was conducted to determine the prevalence of asthma and related symptoms among 6-7 and 13-14 year old school children in Tehran as a part of International study of Asthma and Allergies in childhood (ISAAC) phase III. The ISAAC written questionnaire was given to a total of 6127 students of 72 schools in urban area of Tehran. Simple random sampling was performed with a uniform distribution throughout 12 clusters of 2 divisions of the municipality. All 6-7 and 13-14 year old students were enrolled in this study. Results showed that 15% of the 6-7 year olds and 17% of the 13-14 year olds had positive history of wheezing among which 8.6% and 10.6% respectively had had recent attacks. Physician confirmed asthma was reported in 2.1% of the 6-7 year olds and 2.6% of the 13-14 age group. Severity of asthma assessed by frequency of speech limitation due to wheeze was positive in 1.5% of 6-7 aged group and 3% of 13-14 year olds. Exercise induced wheeze was detected in 2.3% of the 6-7year old group compared to 15.3% of the 13-14 year olds. Nocturnal cough was more prevalent among 13-14 year olds (18.4%) compared to only 7.2% in the 6-7 year olds. Overall, no significant change in prevalence of asthma symptoms has occurred since 1997 (the last phase of ISAAC) among children of Tehran. The results of our study suggest higher rates of confirmed asthma among 6-7 years old girls compared to boys. However, more extensive and precisely designed studies are needed to further confirm these findings.

The implementation of 5 of the 6 WHO MPOWER program in Iran is satisfactory; the only notable shortcoming is the lack of tobacco taxation increases. This study was designed to increase key policy makers' awareness of tobacco taxation effectiveness through a sensitization program in Iran. This analytical and semi-experimental study in 2014 included 110 tobacco control key policy makers, who were trained and received educational materials on the importance of tobacco taxation. A valid and reliable questionnaire was completed before and three months after intervention. Data were analyzed using mean (SD), t-Test and analysis of variance. The mean (SD) scores at pre- and post-test were 2.7 ± 3 and 8.8 ± 1 out of 10, respectively. Paired t-tests demonstrated a significant difference in the pre- post-test knowledge scores. Increasing knowledge and promoting favorable attitudes of policy makers can lead to greater attention which could in turn change tobacco taxation policies.

One Lung Ventilation (OLV) is the preferred method of anesthesia in the vast majority of thoracic operations, especially thoracoscopic procedures. Although double lumen endotracheal tubes are usually used to conduct OLV during thoracic operations, in patients with permanent tracheostomy, because of short trachea, keeping these tubes safe in place is usually difficult. Thus, OLV in patients with permanent tracheostomy may be challenging or even impossible. Herein, we report a patient with permanent tracheostomy who underwent successful OLV and thoracoscopic lobectomy.

The aim of this study was to determine the prevalence of asthma and related symptoms among 6–7- and 13–14-year-old school children in Tehran as a part of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase III. We used a design of descriptive study. The ISAAC written questionnaire was given to a total of 6127 students of 72 schools in urban area of Tehran. Simple random sampling was performed with a uniform distribution throughout 12 clusters of twenty-two divisions of the municipality. All 1st and 7–8th graders were enrolled into the study. Results showed that 15% of the 6–7-yearolds and 17% of the 13–14-year-olds had positive history of wheezing, among which 8.6% and 10.6%, respectively, had had recent attacks. Physician confirmed asthma was reported in 2.1% of the 6–7-year-olds and 2.6% of the 13–14-year-olds. Severity of asthma assessed by frequency of speech limitation due to wheezing was positive in 1.5% of 6–7-year-olds and 3% of 13–14-year-olds. Exercise-induced wheezing was...

To study the participation of the private sector in detection and diagnosis of tuberculosis, all suspected cases referring to 4 private laboratories in Tehran for acid-fast bacillus examination during 2002-03 were documented. Of 9037 cases enrolled in the study, 637 had positive examination results (7.1%). Of these 531 (5.9%) cases were direct smear-positive and 489 (5.4%) were culture-positive. Data from the Iranian Ministry of Health showed 9479 cases referred to government laboratories in Tehran urban area during the study period, 208 (2.2%) of which were positive. This larger than expected proportion of TB patients who are detected and managed by the private sector indicates that much closer cooperation is needed between the public and private sectors.