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   2017| May-June  | Volume 10 | Issue 3  
    Online since August 21, 2017

 
 
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ORIGINAL ARTICLES
Characteristics of an ethical leader: A qualitative content analysis of Iranian nurses' experiences
Fatemeh Esmaelzadeh, Abbas Abbaszadeh, Fariba Borhani, Hamid Peyrovi
May-June 2017, 10(3):684-693
DOI:10.4103/ATMPH.ATMPH_231_17  
Introduction: Leaders' personal characteristics help followers understand them as an ethical leader and increase their attractiveness and credibility as a functional role model. The objective of this study was to identify the characteristics of an ethical leader from Iranian nurses' points of view. Methods: This was a qualitative study based on conventional content analysis, in 2015. Data were collected using deep and semistructured interviews with 17 Iranian nurses. The participants were chosen using purposive sampling until data saturation. For data analysis, MAXQDA 10 software was used based on the conventional content analysis. Findings: The findings emerged as four main categories and 13 subcategories. The categories consist of personal characteristics and professional, leadership, and ethical capabilities. Personal characteristics consist of personal attributes and adherence to religious beliefs. Professional capability consists of interest in the profession, scientific ability, law-abidingness, and dutifulness. Leadership capability consists of charismatic features, effectiveness, and ability to manage emotions and behaviors. Ethical capability consists of moralism, altruism, ethical sensitivity, and ethical courage. Conclusion: Findings of this study help promote characteristics of ethical leaders in nursing, development of an ethical leadership, and ultimately promotion of quality of nursing care.
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Assessing critical gaps in implementation of WHO and UNICEF'S 7-point diarrhea control and prevention strategy in Uttar Pradesh, India
Farhad Ali, Om Prakash Singh, Abhik Dutta, Zaeem Ul Haq, Arindam Ghatak, Trupti Ashtankar
May-June 2017, 10(3):571-579
DOI:10.4103/ATMPH.ATMPH_68_17  
Context: Diarrhea is one of the leading causes of under-five mortality globally and also in India. In the state of Uttar Pradesh, the prevalence of childhood diarrhea is 12.43% and only around half of the children with diarrhea have access to health-care services. Aims: The aim of this study is to understand the critical gaps at the public health system and community levels for the effective implementation of comprehensive diarrhea control. Settings and Design: This study was conducted in the rural settings and data collection was done at health facility and community levels. Subjects and Methods: A mixed methodology was used to conduct this study. Quantitative data were collected through a household survey with 1350 households in four districts and qualitative data were collected through focused group discussions and in-depth interviews at health facility and community levels. Statistical Analysis Used: SPSS was used for quantitative data analysis. Thematic analysis was performed for qualitative data. Results: Mothers are largely aware of use of oral rehydration solution (ORS) but only a third of the children with diarrhea were treated with ORS. Only a fifth of the mothers knew about the use of zinc and just 7% of children with diarrhea were treated with zinc. Majority of the mothers do not wash their hands with soap at critical times. The use of toilet and safe drinking water were also found minimal. There were challenges related to procurement, supply chain of ORS and zinc and also with respect to health human resource capacity at facility and community level. Conclusions: For comprehensive diarrhea control and prevention, health systems and community-level barriers largely related to supplies, training of staff, and community behavior and practices should be addressed.
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Potential safety risks in schools: Ensuring the safety of our precious ones
S Sivasankar Sambasivam, Karmegam Karuppiah, Kulanthayan Subramaniam, Sarva Mangala Praveena, Emilia Zainal Abidin
May-June 2017, 10(3):580-585
DOI:10.4103/ATMPH.ATMPH_81_17  
The school has become an inextricable part of the modern society throughout the world and especially in Malaysia. During the weekdays, schools are typically a hive of activities where the adults (teachers and other workers) and children (students) interact with each other daily. Schools often maintain a low-risk level of safety and health. Schools have potential variety of risk and hazards (physical and social) that can negatively affect the wellbeing and health of the people. The Malaysian Department of Safety and Health (DOSH) have issued the Hazard Identification, Risk Assessment and Risk Control (HIRARC) for identifying the risk elements during usual and special operations and to predict the likelihood and severity in workplaces. This study was carried out to identify all the factors and hazards that may cause harm to occupant of a selected school in the state of Selangor, Malaysia. An assessment was carried out to consider the chances of that harm befalling anyone in the circumstances of a particular case and the possible severity of the outcome to enable school administrators to plan, introduce, and monitor preventive measures to ensure that the risks are adequately controlled at all times. The HIRARC assessment on the selected school identified that physical hazard has the highest frequency, followed by ergonomic, biological, chemical, and psychosocial hazards. The kitchen, science laboratory, and toilet are the areas that have higher potential for accident to happen. Although in terms of risk, most of the hazards are categorized under medium followed by low risk, but none of hazards are categorized under the high-risk group. There is a critical need to ensure that the school environment is constantly kept safe and healthy to ensure that the process of lifelong building of knowledge and practices can be sustained for the future of the nation.
  1,906 18 -
REBA method for the ergonomic risk assessment of auto mechanics postural stress caused by working conditions in Kermanshah (Iran)
Meisam Moradi, Mohsen Poursadeghiyan, Alireza Khammar, Mahsa Hami, Afshin Darsnj, Hamed Yarmohammadi
May-June 2017, 10(3):589-594
DOI:10.4103/ATMPH.ATMPH_107_17  
Background: Work-related musculoskeletal disorders (WMSDs) are among the leading causes of occupational injuries and disabilities in industrialized and developing countries. Objective: This study was aimed at evaluating the ergonomic risk assessment of auto mechanic postural stress due to their working conditions in the city of Kermanshah (Iran) using the Rapid Entire Body Assessment (REBA) method. Materials and Methods: This descriptive–analytical study of cross-sectional type was carried out on 99 auto mechanics in the city of Kermanshah (Iran). In order to determine the prevalence of WMSDs and evaluate the risk of developing WMSDs, the Nordic Body Map questionnaires and REBA method were applied. The data were analyzed by SPSS-16 software. Results: The results showed that the highest prevalence of WMSDs was associated with the back (62.6%) and waist (64.6%). Also, the final obtained score from auto mechanics by the REBA posture assessment method showed that 55.5% are at high and very high risk level. Conclusion: The findings of this study showed that the prevalence of WMSDs in the back and the waist was high. It is, therefore, recommended to improve the working conditions and prevent these disorders by controlling the risk factors related to these areas and removing them from the workplace by taking effective measures. Any prevention programs should focus on risk factors related to these areas.
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EDITORIAL COMMENTARIES
Addressing the challenges of diagnostic delay and longer treatment duration for multidrug resistant tuberculosis: World Health Organization
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):497-498
DOI:10.4103/1755-6783.188509  
  1,542 52 -
A newer toolkit to respond to sexual violence on a global scale: World Health Organization
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):495-496
DOI:10.4103/1755-6783.188510  
  1,457 47 -
ORIGINAL ARTICLES
Study of adenosine deaminase levels in Tb meningitis and its comparision with other types of meningitis
KB Chetan Reddy, Aakash Teja Durbesula, Gangaram Usham
May-June 2017, 10(3):544-550
DOI:10.4103/1755-6783.213172  
Tubercular meningitis is a type of septic meningitis and is a significant cause of morbidity and mortality in developing countries like India due to lack of early and timely diagnosis and so the case of fatality remains higher. Cerebrospinal fluid (CSF) evaluation is single most important aspect of lab diagnosis in meningitis. Aims: 1. To evaluate the diagnostic significance of CSF adenosine deaminase (ADA) activity in tuberculous meningitis. 2. To compare the values of CSF ADA in different types of meningitis and with that of controls. Materials and Methods: It was clinical cross-sectional study of 25 cases of tuberculosis, 25 cases of pyogenic meningitis, and 25 cases of aseptic meningitis. Twenty five controls with age and sex matched individuals without evidence of any neurological diseases served as control for CSF ADA. Results: In this study of 100 patients, 25 (100%) patients of the tubercular group had CSF ADA levels of more than 10 IU/dL with a mean of 13.68 IU/dL with 80% of the patients having ADA levels between 11 and 15 IU/dL. Mean ADA levels of aseptic meningitis was 8.00 IU/dL, pyogenic was 5.76 IU/dL, and control group had mean ADA of 2.12 IU/dL. Conclusion: All patients with tuberculous meningitis had elevated CSF ADA activity. CSF ADA activity in tuberculous meningitis was significantly higher when compared with pyogenic meningitis, aseptic meningitis, and controls.
  1,457 18 -
Epidemiology, incidence, and mortality of gallbladder cancer and its relation with development in the world
Neda Mahdavifar, Reza Pakzad, Mahshid Ghoncheh, Hamidreza Sadeghi Gandomani, Hamid Salehiniya
May-June 2017, 10(3):563-570
DOI:10.4103/1755-6783.213176  
Introduction: Gallbladder cancer is the sixth gastrointestinal cancer and one of the most common cancers of the biliary tract. Awareness about the incidence and mortality of this disease and its distribution in terms of geographical areas for further study and better planning is essential for prevention gallbladder. Therefore, this study was performed with the aim of determining the incidence and mortality of gallbladder cancer and its relationship with the Human Development Index (HDI) in the world in 2012. Methods: The study was conducted based on data from the world data of cancer and the World Bank (including the HDI and its components). Data about the age-specific incidence and mortality rate (ASR) for every country in 2012 were getting from the global cancer project. To analyze data, correlation tests between incidence and death rates, and HDI and its components were employed with a significance level of 0.05 using SPSS software. Results: In 2012, 178101 cases of gallbladder cancer had occurred in the whole world that 76844 cases of them were men and 101257 were women (Sex Ratio = 0.75). In 2012, 142823 deaths from gallbladder cancer had occurred in worldwide that 60339 cases were men and 82484 cases were women (Sex Ratio = 0.73). A positive correlation of 0.402 was seen between gallbladder cancer standardized incidence rate and the HDI that this correlation was statistically significant (P < 0.001). Also, a positive correlation of 0.261 was seen between the standardized mortality rate of gallbladder cancer and the HDI that this association was statistically significant (P = 0.001). Conclusion: Countries with high incidence of gall bladder carcinoma have higher mortality rates too. A significant correlation was seen between the standardized incidence and mortality rate of gallbladder cancer and the HDI and its dimensions (life expectancy at birth, average education). Further studies about the causes of this disease can be useful.
  1,381 20 -
Application of an outcome present test-peer learning model to improve clinical reasoning of nursing students in the intensive care unit
Edy Wuryanto, Gandes Retno Rahayu, Ova Emilia, Harsono , Arieza Putri Revina Octavia
May-June 2017, 10(3):657-663
DOI:10.4103/ATMPH.ATMPH_201_17  
Aim: High clinical reasoning skills are required by nurses in the intensive care unit (ICU). Nurses should perform clinical reasoning and make important clinical assessments and decisions for the provision of nursing care in the ICU. However, they often have difficulty in making decisions because of a lack of skills and proficiency in clinical reasoning methods. The outcome present test model through peer learning (OPT-peer learning) constitutes one of the important strategies to improve clinical reasoning skills. This research is aimed to explore the experience of nursing students and clinical instructors, following the application of the OPT-peer learning model. This phenomenology study was conducted with eight students of the nursing profession and four clinical instructors after applying the model of OPT-peer learning for 6 weeks. Materials and Methods: Data were collected through focus group discussions and in-depth interviews. Thematic analysis techniques were applied using Atlas.ti software version 6.1. There are six themes identified from participants pertaining to their experience in using the OPT-peer learning model: The model facilitates the guidance process; improves clinical reasoning skills; strengthens self-directed learning; triggers a successful group process; strengthens use of interrelated terminology of the North American Nursing Diagnosis Association (NANDA), Nursing Intervention Classification (NIC), and Nursing Outcome Classification (NOC); and facilitates the preparation of report documentation. Results: The OPT-peer learning model can be applied as an effective learning strategy for developing clinical reasoning skills in the students of the nursing profession who take specialization in the ICU. Training on the OPT-peer learning model, especially the mastery of its modules and terminologies of NANDA, NIC, and NOC, is needed before the model is applied.
  1,372 19 -
LETTERS TO THE EDITOR
New view on health policies of the Islamic Republic of Iran: Health system reform
Ali Mehrabi Tavana, Mohammad Meskarpour Amiri
May-June 2017, 10(3):767-768
DOI:10.4103/1755-6783.188524  
  1,306 55 -
Zika virus disease: Potential risk for the athletes and the international visitors in the Rio Olympic Games, 2016
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):762-764
DOI:10.4103/1755-6783.188514  
  1,255 39 -
ORIGINAL ARTICLES
The correlation between the clinical competency and empathy of nurses: Case study, Intensive Care Units of the educational hospitals of Kerman Medical Sciences University, Iran
Zohre Jahanshahi, Alireza Ghahri Sarabi, Fariba Borhani, Malihe Nasiri, Sima Zohari Anboohi
May-June 2017, 10(3):694-701
DOI:10.4103/ATMPH.ATMPH_233_17  
Background and Purpose: Special nursing is considered an expertise in nursing profession and requires a special competency. Empathy is complementary to the skills and knowledge needed to effectively treat a patient. Clinical competency and empathy are followed by effective health cares. The aim of this study was to assess the correlation between clinical competency and empathy of nurses employed in Intensive Care Units (ICUs). Methodology: This descriptive, correlational study was carried out on 231 nurses employed in the ICUs of the educational hospitals of Kerman University of Medical Sciences that were selected through a census. The data collection tools included an intensive care nursing competency scale and a nursing empathy assessment questionnaire. Data were analyzed using the SPSS version 20 software and the independent t-test, ANOVA, Pearson's correlation coefficient and regression. Results: The study results indicated that the mean score of nurses' clinical competency was 574.08 ± 86.51, and the mean score of empathy was 150.12 ± 17.04. The highest level of clinical competency belonged to the field of knowledge, and the lowest level belonged to the field of skill. The highest level of empathy was related to the behavioral area, and lowest level was related to the emotional area. There was a correlation between the two variables of clinical competency and empathy and all of their areas (the overall correlation coefficient r = 0.7 and P < 0.001). Conclusion: Given the relationship between clinical competency and empathy, it can be concluded that a higher clinical competency in nurses makes them more likely to establish an empathetic relationship with patients. According to the findings of this research, nursing managers and nursing education planners can provide appropriate conditions to enhance the clinical competency of nurses and improve their chance of establishing empathetic relations.
  1,261 19 -
LETTERS TO THE EDITOR
Triple coinfection – dengue, chikungunya, and Zika virus infection: Risk and next possibility for “more than three” combination
Beuy Joob, Viroj Wiwanitkit
May-June 2017, 10(3):757-758
DOI:10.4103/1755-6783.188508  
  1,202 40 -
Taking major strides in dengue vaccine research: World health organization
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):743-744
DOI:10.4103/1755-6783.188500  
  1,194 40 -
EDITORIAL COMMENTARIES
Self-care and self-medication: A commentary
Tanmay Mahapatra
May-June 2017, 10(3):505-506
DOI:10.4103/1755-6783.213160  
  1,211 18 -
ORIGINAL ARTICLES
Effect of educational intervention on self-care behaviors among patients with diabetes: An application of PRECEDE model
Seyed Ghadir Hosseini, Davoud Shojaeizadeh, Akram Sanagu, Mohammad Ali Vakili, Kamal Mirkarimi, Reza Jahanshahi
May-June 2017, 10(3):707-714
DOI:10.4103/ATMPH.ATMPH_242_17  
Introduction: Diabetes is a common noncommunicable disease across the world with a remarkable rate of early death in some countries. This survey aimed to assess the effect of educational intervention on self-care behaviors among patients with diabetes, an application of PRECEDE model. Materials and Methods: A randomized control trial study was conducted on 106 patients with type 2 diabetes who had active records in the diabetes clinics (just two clinics) in the Iranian city of Gorgan. Patients were randomly assigned into control (53 patients) and intervention (53 patients) arms. Data were collected using a three-part questionnaire including (1) a self-care behavior questionnaire based on PRECEDE model, (2) a checklist of demographic and anthropometric characteristic, and (3) a patient sheet to record glycated hemoglobin (HbA1C). To analyze data, Shapiro–Wilk, ANOVA repeated measure, Tukey tests, and linear regression model were applied. P < 0.05 was taken into account as statistically significant. Results: The mean age of patients in the control and intervention groups was 58.09 ± 1.6 and 51.55 ± 8.3 years, respectively. HbA1C and body mass index were more decreased in the intervention group as compared to the control group. At 6 months follow-up, enabling factors, knowledge, and attitude were the strongest predictors of the self-care behaviors. Conclusion: Designing an educational intervention based on PRECEDE model appeared to be likely useful to promote self-care behaviors and control diabetes among patients with type 2 diabetes.
  1,197 19 -
Exploring the HIV-risk practices of men who have sex with men in Port Harcourt city, Nigeria
Charles I Tobin-West, Stephen Nwajagu, Omosivie Maduka, Emmanuel Oranu, Victor Nnanna Onyekwere, Igbiks Tamuno
May-June 2017, 10(3):551-557
DOI:10.4103/1755-6783.168721  
Background: Most men who have sex with men (MSM) in Nigeria are said to engage in high-risk sexual practices. This study aims to highlight these risk practices and proffer probable control solutions. Materials and Methods: A descriptive cross-sectional design and a purposive sampling method were used to interview 101 MSM linked to a clandestine network in a city suburb in Port Harcourt in October 2014. Data was analyzed using SPSS version 21.0. Univariate analysis was done to establish associated risk factors. Confidence limit was set at P = 0.05. Results: The age of study participants ranged between 18 and 45 years (mean = 25.35 years). The majority, 88 (87.1%) were single, had tertiary education and bisexuals, 85 (84.2%). Most, 62 (61.4%) reported to have between two and five sexual partners, while only 57 (53.4%) used condoms consistently with casual partners. All participants have heard about HIV, but only 70 (69.3%) had ever tested for HIV, while only 25 (28.1%) knew the HIV status of their sex partners. In the last 6 months preceding the study, 62 (61.4%) had insertive anal intercourse, while 57 (54.4%) had receptive anal intercourse. Also, 42 (41.6%) and 20 (19.8%), respectively, admitted to regular alcohol and Indian hemp use before sex. Finally, 70 (69.3%) used the internet in search of sex partners. Conclusions: MSM in Port Harcourt city engage in high-risk sexual practices. Emphasis on condom programming and promotion of pre-exposure prophylaxis in the National antiretroviral program might be useful in curbing the HIV epidemic among MSM. Key Messages: The use of the internet in search of sexual partners, alcohol use before sex, multiple sex partners, limited condom use and soaring transactional sex, all appear to be significant drivers of sexual risk taking among young men who have sex with men in Port Harcourt.
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The effects of the manner of carrying the bags on musculoskeletal symptoms in school students in the city of Ilam, Iran
Mohsen Poursadeghiyan, Keykaous Azrah, Hamed Biglari, Mohammad Hossein Ebrahimi, Hamed Yarmohammadi, Mohammad Mehdi Baneshi, Mahsa Hami, Alireza Khammar
May-June 2017, 10(3):600-605
DOI:10.4103/ATMPH.ATMPH_109_17  
Background: Musculoskeletal disorders are a major public health problem. Recently, there has been an increase in musculoskeletal disorder complaints among school students. Objective: The aim of this study was to identify the factors affecting students' physical stature and the manner of carrying bags by them in Ilam, Iran. Materials and Methods: A total of 244 students were randomly selected to participate in the study. A questionnaire was designed to collect required data. The Nordic Musculoskeletal Questionnaire was used to find out complaints related to back, neck, and shoulder disorders. The height was measured using a portable stadiometer. A digital scale was used to measure the weight of students and their bags. Results: About 50% of the primary students reported discomforts in shoulder. The weights of bags carried by 66.4% of students were lighter than 10% of their body weight. Most students with different physical problems had tarpaulin bags. There was a significant relationship between the manner of carrying bags and their design (P < 0.05). Conclusion: The manner of carrying bags is an important factor among primary school children because carrying of heavy bags is clearly the effective factor and may be ignored as a physical stressor for primary students.
  1,151 18 -
LETTERS TO THE EDITOR
Reactome analysis of Zika virus genes: Implication for pathogenesis
Somsri Wiwanitkit, Viroj Wiwanitkit
May-June 2017, 10(3):755-755
DOI:10.4103/1755-6783.188507  
  1,130 37 -
Upscaling of interventions for the control of Echinococcosis and its associated complications
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):737-738
DOI:10.4103/1755-6783.188496  
  1,121 38 -
ORIGINAL ARTICLES
Studying the level of knowledge, attitude, and performance among personnel of Doctor Mohammad Kermanshahi and Hazrat Masomeh Hospitals in terms of hospital waste management
Parviz Mohammadi, Shoeib Rahimi, Taibeh Dashtaleh, Younes Sohrabi
May-June 2017, 10(3):612-617
DOI:10.4103/ATMPH.ATMPH_111_17  
Introduction: Waste is the most original important environmental contaminate. The most important point to be considered in hospital activities is waste management because of its importance. Objective: The aim of the study was to determine the level of knowledge, attitude, and performance among personnel of Doctor Mohammad Kermanshahi and Hazrat Masomeh Hospitals in terms of hospital waste management which this study was performed in 2015. Materials and Methods: This cross-sectional study was conducted as a descriptive analysis to evaluate the knowledge, attitude, and performance level of 229 personnel of Doctor Mohammad Kermanshahi (123 people) and Hazrat Masomeh (105 people) Hospitals in terms of hospital waste management. The data were collected by a questionnaire consisted of four parts as follows: demographic, knowledge, attitude, and performance characteristics. In order to analyze the data, SPSS software, Mann-Whitney, nonparametric Kruskal–Wallis, and independent t parametric tests were used. Results: The results showed that sex affects the personnel performance and attitude of Doctor Mohammad Kermanshahi Hospital. There was a significant effect between men and women of Hazrat Masomeh Hospital in the knowledge, attitude, and performance levels. In the personnel of Doctor Mohammad Kermanshahi Hospital, the attitude was different among different occupational groups, the highest rate was related to occupational condition, and the lowest was related to nurses' career status. However, in the personnel of Hazrat Masomeh Hospital, there were no significant results between knowledge, attitude, and performance. Conclusion: Based on the data for each variable in different job situations, it can be deduced that the average knowledge of personnel working in the supportive section was 15.97 which means that they had maximum knowledge and the average knowledge for nurses with 14.92 had the lowest knowledge. In the performance variable, the highest average (14.72) was related to the staffs who worked as supportive group and the physicians had the lowest performance with average score of 13. Finally for attitudes variable the highest average was for physician with 53 and the lowest for nurses with 50.07. According to these results, it can be recommended that training to the hospital staff as well as necessary regulation codification which emphasis on waste management and separation in hospitals.
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Emergence of scrub typhus in Odisha – A hospital based study
Sibabratta Patnaik, Natabar Swain, Bandya Sahoo, Reshmi Mishra, Mukesh Kumar Jain
May-June 2017, 10(3):636-640
DOI:10.4103/ATMPH.ATMPH_144_16  
Background: Scrub typhus was unseen in Odisha, but during postmonsoon months of 2014, for the first time, 25 cases of scrub typhus were identified in the pediatric department of Kalinga Institute of Medical Sciences, Bhubaneswar. Objectives: This study aimed at analyzing the demographic pattern, symptomatology, complications, and response to therapy, which will help medical fraternity in early diagnosis and management. Materials and Methods: By retrospective analysis of case records between September 2014 and February 2015, 25 children were found to have scrub typhus by the detection of specific IgM by enzyme-linked immunosorbent assay (ELISA) method. Results: Main clinical manifestations were prolonged fever (100%), respiratory distress (44%), shock, hepatomegaly (96%), splenomegaly (68%), lymphadenopathy (24%), and third spacing (40%). The characteristic eschar was found in 48% children (n = 12). Laboratory findings were leukocytosis (44%), thrombocytopenia (24%), raised C-reactive protein (96%), and transaminitis (76%). All cases were found to be positive for specific IgM by ELISA method (100%). Complications detected were myocarditis (28%), encephalopathy (12%), acute respiratory distress syndrome (4%), and multiorgan dysfunction. Twenty-four cases received doxycycline and all improved, whereas one child who did not get doxycycline expired (died within 24 h of hospitalization). Discussion: Vasculitis is the basic pathogenic mechanism in scrub typhus. An eschar is the most characteristic and pathognomonic feature of scrub typhus but not seen in all patients. If a combination of elevated transaminases, leukocytosis, and thrombocytopenia is found, then specificity and positive predictive value for diagnosis are about 80%. Doxycycline is the drug of choice. Conclusion: Pediatricians and physicians must be aware of scrub typhus for early diagnosis and treatment of this emerging disease.
  1,133 19 -
LETTERS TO THE EDITOR
Rising global estimates of dementia: An urgent public health need to stem the tide
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):741-742
DOI:10.4103/1755-6783.188498  
  1,105 38 -
ORIGINAL ARTICLES
Comparison of the effects of propofol and dexmedetomidine on controlled hypotension and bleeding during endoscopic sinus surgery
Esmail Moshiri, Hesameddin Modir, Bijan Yazdi, Alireza Susanabadi, Neda Salehjafari
May-June 2017, 10(3):721-725
DOI:10.4103/ATMPH.ATMPH_264_17  
Introduction: Due to the nature of the space that endoscopic sinus surgery is performed in it, even a small amount of bleeding has a negative effect on surgeon vision. The aim of this study was to compare the effects of propofol and dexmedetomidine on controlled hypotension and bleeding during endoscopic sinus surgery. Materials and Methods: In this randomized clinical trial, 100 patients candidate for endoscopic sinus surgery entered the study. The patients were randomly divided into two groups. In the first group, Group D, 1 μg/kg dexmedetomidine was injected within 10 min as the initial dose and 0.4–0.8 μg/kg/h infusion was continued. In Group P, 50–150 μg/kg/min Propofol was infused. Hemodynamic parameters were measured from the onset of the study to 120 min after surgery, and the intraoperative bleeding was reported by surgeon. Results: Mean score of bleeding was 1.14 ± 0.70 in Group D and 1.24 ± 0.74 in Group P (P = 0.490). Wilks' group Lambda test showed a significant reduction in heart rate of both groups (F = 3.45, P = 0.002). Heart rate in Group P was significantly lower than Group D (Greenhouse-Geisser test, F = 2.70, P = 0.015). There was no statistical difference in mean arterial pressure and O2saturation. The average time of patients recovery was 32.52 ± 7.9 min in Group D and 29.90 ± 10.6 min in Group P (P = 0.166). Conclusion: Propofol could reduce heart rate significantly more than dexmedetomidine. However, about reduction of bleeding and obtaining an appropriate surgical field which were the main outcomes of the study, there was no significant difference between groups.
  1,123 19 -
Health risk assessment of exposure to heavy metals in dairy products collected from Bushehr, Iran
Seyed Enayat Hashemi, Hossein Arfaeinia, Saeed Ardashiri, Kamaladdin Karimyan
May-June 2017, 10(3):632-635
DOI:10.4103/ATMPH.ATMPH_118_17  
Background: Assessment of dairy products can identify the presence of heavy metals in them that poses a serious threat to human health and is a major concern on a global scale. Objective: The aim of this research was to evaluate the heavy metal concentrations in dairy products and their potential risks in urban areas in Bushehr city, Iran. Materials and Methods: A total of 71 dairy product samples (16 milk, 14 yoghurt, 15 cheeses, 13butter, 11 dough, and 12 creams) were collected randomly from dairy shops in Bushehr city, Iran and analyzed by using a flame atomic absorption spectrophotometer. Results: The results of this research showed that the concentrations of lead in cream and butter were significantly higher than in milk and yoghurt samples (P < 0.05). In addition, the levels of cadmium in cream and cheese were significantly higher than in milk samples (P < 0.05). Moreover, zinc contents in cheese and cream were significantly higher than in milk and butter (P < 0.05). The concentrations of Cu were significantly higher in butter and cream than in milk, cheese, and dough samples. Conclusion: The findings of the work obviously demonstrated that the daily intake of dairy products involved a tolerable amount of Pb and Cd. Therefore, the intake of dairy products in the study area is almost without potential risks.
  1,113 27 -
LETTERS TO THE EDITOR
Holy incorruptible bodies and tropical medicine studies
Won Sriwijitalai, Viroj Wiwanitkit
May-June 2017, 10(3):753-753
DOI:10.4103/1755-6783.188504  
  1,089 39 -
Zika virus infection and breastfeeding
Beuy Joob, Viroj Wiwanitkit
May-June 2017, 10(3):752-752
DOI:10.4103/1755-6783.188503  
  1,063 42 -
Targeting health sector to tackle the menace of female genital mutilation
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):761-762
DOI:10.4103/1755-6783.188513  
  1,062 38 -
Planning a concerted effort to minimize the adverse consequences of cannabis: Public health perspective
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):749-750
DOI:10.4103/1755-6783.188502  
  1,044 39 -
Recommended strategies to respond to the challenge of poor immunization coverage in Low-and Middle-income nations
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):746-747
DOI:10.4103/1755-6783.188501  
  1,009 38 -
Targeting the underestimated and underdiagnosed global problem of headache disorders
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):739-740
DOI:10.4103/1755-6783.188497  
  1,007 37 -
ORIGINAL ARTICLES
Occupational health, safety, and ergonomics challenges and opportunities based on the organizational structure analysis: A case study in the selected manufacturing industries in Qom Province, Iran, 2015
Mohammad Khandan, Mohaddeseh Haji Aligol, Masumeh Shamsi, Mohsen Poursadeghiyan, Hamed Biglari, Alireza Koohpaei
May-June 2017, 10(3):606-611
DOI:10.4103/ATMPH.ATMPH_110_17  
Background: A suitable organizational structure plays an important role in the efficiency and predictability of different parts of organizations. Objectives: The aim of the study was to assess the organizational structure of the selected manufacturing industries located at the Qom Province, and its relations to occupational health and safety concerns and success in 2015. Materials and Method: This cross-sectional study was conducted among 39 randomly chosen manufacturing companies. The data collection was conducted using valid Robbins's organizational structure questionnaire. Higher scores indicate higher levels of the respective components. Questionnaires were completed by middle managers of selected companies. Data were analyzed by Pearson correlation using SPSS version 20. Results: The average number of the employed personnel in these companies and organizations' work experience was 105.1 ± 101.1 persons and 15.3 ± 12.1 years, respectively. Average scores of complexity, formalization, and centralization was 14.3, 21.3, and 31.2, respectively. Among the studied organizations, 38.6% of the organizations had formalization, 2.6% had complexity, and 56.6% had high centralization. The results of Pearson's correlation test showed that there was a relation between complexity and organizational size, as well as centralization and work experience of the company significantly (P < 0.05). Conclusion: More than half of the studied organizations had a centralized structure. It should be noted that at a low level authority status, activities related to the health, safety, and ergonomics (HSE) field cannot have the appropriate performance. In addition, it revealed that more than 60% of the studied companies had not formalization. In summary, based on the results of the present study, favorable future conditions of HSE situation is not predictable.
  1,020 19 -
LETTERS TO THE EDITOR
Minimizing the rates of unsafe abortion in developing nations
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):760-761
DOI:10.4103/1755-6783.188512  
  998 36 -
ORIGINAL ARTICLES
Incidence of impacted maxillary canine teeth in Saudi Arabian subpopulation at central Saudi Arabian region
Satheesh B Haralur, Saeed Al Shahrani, Faris Alqahtani, Yunal Nusair, Omar Alshammari, Omar Alshenqety
May-June 2017, 10(3):558-562
DOI:10.4103/1755-6783.213175  
Objective: To estimate the incidence of maxillary canine impaction, its location, and mean impaction angle to the occlusal plane. Introduction: The canine teeth are important both aesthetically and functional occlusion. The maxillary canine impaction is genetically linked. Hence, the knowledge of prevalence in the local population is essential. Understanding the location of cuspid impaction is critical to initiate a preventive and therapeutic surgical or orthodontics interventions. Along with other clinical examinations, the impaction angle can also be used to differentiate the impaction location. Material and Methods: A total of 8517 patient's radiographs at the Dental Department of King Abdul Aziz Medical City, Riyadh, were retrospectively evaluated. The age group of the patient included in the study was between 18 and 45 years. The patient's records and radiographs were evaluated to register the impacted maxillary canines, location, and angulation to the occlusal plane. The obtained data were evaluated with SPSS 19 software to analyze the incidence and difference between the genders. Results: Total of 291 patients had the impacted maxillary cuspid. The additional radiograph was available with 44 patient records to further analyze the location of impaction. Among 44 patients, 17(38.64%) were males and 27(61.36%) female subjects. The seven (15.9%) of the cuspids were labially impacted, whereas 37(84.1%) were palatally impacted. The mean impaction angles for labial and palatal impactions were 57.65 and 65.4 degrees, respectively. Conclusions: The majority of canine impaction were palatally placed in comparison to labial impaction. The mean impaction angle of labial impaction is lesser than that of palatal impactions.
  995 19 -
LETTERS TO THE EDITOR
Rate of penicillin allergy among health people: Observation from screening penicillin skin test
Won Sriwijitalai, Viroj Wiwanitkit
May-June 2017, 10(3):759-760
DOI:10.4103/1755-6783.188511  
  978 34 -
ORIGINAL ARTICLES
The relationship between quality of life, spirituality, and resilience and suicidal thoughts in students of Razi University
Khoda Morad Momeni, Shaban Moradi, Saeed Dinei, Alireza Shahrestani, Mohammad Dinei, Fereshteh Mohammadi, Maryam Dabirian
May-June 2017, 10(3):586-588
DOI:10.4103/ATMPH.ATMPH_106_17  
Background: Suicide is a mental health crisis and it has increased in recent years among university students. Studying the effective and predictor factors in suicidal thoughts can be helpful in understanding positive aspects and adaptive behavior of students. Objective: The relationship between quality of life, spirituality, and resilience and suicidal thoughts in students of Faculty of Sociology, Kermanshah Razi University, was studied through a descriptive, correlational study. Materials and Methods: The study population comprised all students in Faculty of Sociology, Kermanshah Razi University; a sample group of 200 participants was formed by using the multistage cluster sampling. Beck's Scale of Suicidal thoughts (BSSI), quality of life (SF-36), Conner and Davidson Resilience Scale (CD-RISC), and Qobari's spiritual experiences questionnaire were used for data collection. The collected data were analyzed using statistics mean, SD, Pearson correlation coefficient, and regression analysis. Results: The study showed that among the predictor variables, resilience and quality of life had more capacity to predict suicidal thoughts. The results also showed that quality of life and resilience were significantly and negatively related to suicidal thoughts. Conclusions: Given that such thoughts are the starting point of the process that leads to the act of committing suicide and several factors such as physical, mental, social, family factors, and so on, may contribute to the development of these thoughts, similar studies are necessary to be conducted in other geographical regions and universities, and the results should be used to control the factors that affect suicidal thoughts. Based on these results, consultants providing services to university students need to pay more attention to the role of resilience and improvement in quality of life of the students to reduce suicidal thoughts in them.
  942 19 -
EDITORIAL COMMENTARIES
Tackling the public health concern of the double burden of malnutrition on the global scale
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):493-494
DOI:10.4103/1755-6783.213142  
  895 19 -
ORIGINAL ARTICLES
Maternal empowerment holds the key to reducing stunting during first 1000 days of life: Evidence from a case–controlled study
Pavan Pandey, Prashant Bajpai, Sneha Jain, Arushi Sharma
May-June 2017, 10(3):667-677
DOI:10.4103/ATMPH.ATMPH_228_17  
Objective: Stunting during the first 2 years of life can affect child's cognitive development, schooling, and earning potential. The objective of the study is to identify the determinants of severe stunting among children aged 2 years of age. Materials and Methods: We conducted a case–control study involving 289 severely stunted children as cases and 578 children with normal height as controls. Household-, maternal-, pregnancy-, and child care-related data were collected. Adjusted odds ratio (AOR) with confidence interval (CI) was calculated. Results: Multivariate regression analyses indicated that mother having short stature (AOR = 1.92 [95% CI = 1.14–3.52]), severe anemia during pregnancy (AOR = 1.98 [95% CI = 1.13–3.82]), weight gain <8 kg during pregnancy (AOR = 6.36 [95% CI = 4.08–10.81]), birth weight <2 kg (AOR = 5.96 [95% CI = 4.22–8.92]), a younger sibling (AOR = 12.62 [95% CI = 8.63–18.52]), and not receiving Vitamin A supplementation (AOR = 2.78 [95% CI = 1.87–4.45]) were associated with higher odds of severe stunting among children aged 2 years. Conclusion: Most of the factors associated with severe stunting were directly or indirectly related to child's mother. Thus, educating and empowering mother (s) for self-care before, during, and after pregnancy and about child care practices during first 2 years of life are crucial for reducing stunting in the first 1000 days of life.
  874 22 -
REVIEW ARTICLE
The application of biomarker in determining genotoxic potential of polyaromatic hydrocarbon exposure among children
Nor Ashikin Sopian, Juliana Jalaludin
May-June 2017, 10(3):533-543
DOI:10.4103/ATMPH.ATMPH_92_17  
Introduction: The quality of ambient air of industrial and urban area are often characterized by the distribution of polyaromatic hydrocarbons (PAHs) in the atmosphere. PAHs, has been associated with increasing risk of cancer especially among susceptible individual in human population such as children. Investigations of chronic health effect of PAHs can be aided with the help of biomarker application in understanding exposure, mechanism of toxicity, and level of susceptibility. Method: In this article, materials obtained from several online databases such as PubMed, Proquest, Scopus, and Science Direct from 2000 to 2015 were reviewed. The application of biomarker of PAHs exposure and effect among children living in areas with high traffic density and industrial area were summarized. From these two different environments settings, an insight into different exposure of PAHs and it association with health outcomes were given. Results: Fifteen biomarker-associated studies were reviewed. Most of the studies emphasized on the application of urinary 1-hydroxypyrene (1-OHP) and DNA adduct as biomarkers of exposure to PAHs. On the other hand, biomarker of effect was frequently represented by cytogenetic analysis. Which includes chromosomal aberrations, sister chromatid exchanges, micronuclei, comet assay parameters like tail length and percentage of DNA in tail. Conclusion: The application of biomarker in revealing the level of PAH exposure and genotoxicity among children is highly preferable. However, the biomarker itself is still considered insufficient to conclude the toxicity of PAH exposure from traffic and industrial emissions. The environmental monitoring is included in the study in order to understand the correlation of ambient PAHs and health outcomes.
  839 21 -
ORIGINAL ARTICLES
Study of the administration impact of titanium dioxide nanoparaticles during pregnancy on hemetological parameters and lipid profile in the mice offspring
Mazyar Fathi, Faramarz Jalili, Parnian Jalili, Mohammad Reza Salahshoor, Mahdi Taghadosi, Maryam Sohrabi, Fariborz Bahrehmand, Cyrus Jalili
May-June 2017, 10(3):618-622
DOI:10.4103/ATMPH.ATMPH_112_17  
Introduction: Nanotechnology is a developing technology whose use is increasing in different aspects. Among various nanostructures that are widely used, we can refer to titanium dioxide nanoparticles (Tio2-np), which are applied in water and wastewater treatment, antibacterial and antifungal substances, and self-cleaning surfaces; however, due to passing of the particles through placenta and blood–brain barrier, it may cause pathological damages in infants and affect the future generations' health. Objective: The aim of this study is to investigate the impact of administration of titanium dioxide nanoparticles during pregnancy on hematological parameters and lipid profile in the mice offspring. Materials and Methods: In this experiment, 30 female mice were divided into three groups, including the control group who received no substance, the solvent group who received drug carrier on the 3rd, 7th, 10th, and 14th days of pregnancy, and the treatment group who received subcutaneously 10 μL of titanium dioxide nanoparticles of 1 mg/mL concentration in the 3rd, 7th, 10th, and 14th days after mating. Afterwards, among the offspring of each group, 10 male and 10 female offspring were chosen to evaluate hematological parameters and lipid profile on the 42nd day. Results: The results demonstrated that offspring exposure to prenatal titanium dioxide particles (Tio2-NP) in the treatment group causes changes in hematological parameters and lipid profile levels in male and female offspring; however, changes were greater in female offspring. Conclusion: Since previous studies have shown that titanium dioxide nanoparticles have the ability to cross the placenta and blood–brain barrier. After passing the barriers, they cause damages to various organs including liver and kidney and also changes in gene expression levels in different parts of the body including brain and bones. In addition, they result in producing free radical in the body and developing disorders in globules production and lipid metabolism.
  830 22 -
Comparing the frequency of occupational injuries among medical emergency staff and nurses of Intensive Care Units in Hamadan
Ali Afshari, Arash Khalili, Maryam Dehghani, Mehdi Beiramijam, Mojtaba Daneshgari Lotf, Farshid Alazmani Noodeh, Khodayar Oshvandi
May-June 2017, 10(3):646-650
DOI:10.4103/ATMPH.ATMPH_182_17  
Background: The occupational injury can lead to partial disability or sick leave of nursing staff and prehospital emergency services for a certain period of time. This study aimed to compare the frequency of occupational hazards emergency medical and nursing staff of Intensive Care Units (ICUs) in Hamadan. Materials and Methods: In this cross-sectional study, a standard questionnaire was distributed to all emergency personnel, doctors, and nurses of ICU in Hamadan. The collected data analyzed by SPSS version 16 to compare occupational injuries that inferential statistics, Chi-square test, and Fisher's exact test were used. Results: Out of 340 questionnaires distributed among the emergency medicine personnel and nurses, 147 questionnaires were returned. The most frequent occupational injuries (84.5%) by aged 20–30 years, Also the highest frequency of injury in the area of emergency medicine personnel spine (66%) and nurses' legs (72.3%). Its difference between the areas affected by the type of job and the relationship between job and the risk factors causing significant damage was compared between nurses and emergency medicine personnel (P > 0.001). Conclusion: To prevent damage to the occupational and medical personnel because of the sensitivity of musculoskeletal injuries, recommended strategies for the prevention of occupational injuries to be included in training programs for health personnel.
  826 18 -
Effects of bright light shock on sleepiness and adaptation among night workers of a hospital in Iran
Alireza Khammar, Maryam Moghimian, Mohammad Hossein Ebrahimi, Milad Abbasi, Mohammad Mehdi Baneshi, Ahmad Reza Yari, Mahsa Hami, Mohsen Poursadeghiyan
May-June 2017, 10(3):595-599
DOI:10.4103/ATMPH.ATMPH_108_17  
Background: Night work has many harmful effects on health, efficiency, and industrial safety of workers. Night workers often complained of sleepiness, decrease of performance, and sleep disorder due to the lack of circadian influence that fully encourages night orientation. Objective: This research was conducted in an industrial environment and it accessed the effects of bright-light (BL) exposure on sleepiness during night work. Materials and Methods: This is an interventional study with a cross-over design. A total of 140 night workers with an experience of >1 year at a hospital participated voluntarily in this study. The night workers were divided into two groups, and both groups were exposed to either BL (3000-3500 lux) or normal light (NL) (400 lux) during break times at night work for two consecutive nights. Results: The 15-minute breaks were initiated at 22:00 (before starting work), 24:00, 2:00, and 4:00 h. The range of sleepiness was assessed by the Karolinska Sleepiness Scale (KSS) at 23:00, 1:00, 3:00, and 5:00 h. We used SPSS16 software for data analysis. The results obtained using the paired t-test analysis (P < 0.000) demonstrated that there were significant differences in the rate of sleepiness between the two groups (case and control). Conclusion: The findings of the present study have also demonstrated the feasibility and benefits of photic stimulation in industrial settings which increased the adaptation to night work.
  821 19 -
CASE REPORTS
Primary torsion of vermiform appendix: A case report and review of literature
Vipul D Yagnik
May-June 2017, 10(3):731-733
DOI:10.4103/ATMPH.ATMPH_25_17  
Appendicitis is the most common abdominal emergency with more than 250,000 appendectomy operations performed annually in the United States alone. Although appendicitis is the most common intra-abdominal surgical pathology, torsion of the appendix has only rarely been described and is an uncommon cause of an acute abdomen. The clinical picture is the same as that for acute appendicitis, and it is difficult to distinguish between them preoperatively. A case of primary torsion of the vermiform appendix is reported here along with pertinent literature review.
  813 18 -
ORIGINAL ARTICLES
Care: The first priority of professional values from the perspective of Iranian
Mahsa Boozaripour, Abbas Abbaszadeh, Mohsen Shahriari, Amir Almasi Hashiani, Fariba Borhani
May-June 2017, 10(3):678-683
DOI:10.4103/ATMPH.ATMPH_230_17  
Background: All nurses from nursing students to the highest levels are expected to act professionally according to professional values. The aim of this study was to evaluate professional values from the perspective of nursing students of School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Materials and Methods: In this cross-sectional survey, we investigated the professional values of the nursing profession among 366 Bachelor's degree nursing students selected through simple random sampling. A two-part questionnaire containing demographic features and the Nursing Professional Values Scale-Revised developed by Weis and Schank with 26 items in the Likert scale were used after translation and validation. Results: The mean total score of the students in this scale was 4.1. Considering the mean and SD of each domain of the scale, the participants gave a higher score to “caring” and a lower score to “activism.” Simple linear regression analysis showed a significant relationship between the score of professional values and age (regression coefficient = 0.023, P = 0.013), grade point average (regression coefficient = 0.080, P = 0.050), and semester (regression coefficient = −0.098, P = 0.001). Conclusions: The present study showed that environmental factors, modeling from other professionals, and overt and covert training affected the students' perspective of professional values.
  805 18 -
Evaluation of in vitro activity of tigecycline against carbapenemase-producing Gram-negative clinical isolates
Rajkumar Manojkumar Singh, Urvashi Chongtham, Smeeta Huidrom, Huidrom Lokhendro Singh
May-June 2017, 10(3):641-645
DOI:10.4103/ATMPH.ATMPH_146_17  
Introduction: The emergence of carbapenem-resistant Gram-negative pathogens poses a serious overwhelming threat to public health worldwide. The paucity in developing novel antimicrobials escalates the antimicrobial resistance problem, severely reducing the available therapeutic options. Tigecycline, a broad-spectrum glycylcycline, is considered the last-resort antimicrobial agent for the treatment of multidrug-resistant Gram-negative bacteria, except for Pseudomonas aeruginosa and Proteus spp. Objectives: This study was conducted to assess the activity of tigecycline against carbapenem-resistant Gram-negative clinical isolates. Materials and Methods: A total of 247 consecutive, nonrepeat carbapenem-resistant Gram-negative clinical isolates, detected by the VITEK 2 Compact system with advanced expert system, were obtained during the period from January 2012 to December 2015. Minimal inhibitory concentrations to tigecycline were determined using agar dilution method, and the results were interpreted using Food and Drug Administration (FDA) and EUCAST breakpoints. Results: The minimum inhibitory concentration (MIC) of tigecycline required to inhibit the growth of 90% of organisms (MIC90) varied from 1 to 8 μg/ml for the study isolates, except for P. aeruginosa and Proteus mirabilis where MIC90is ≥16 μg/ml. Using FDA breakpoint, sensitivity rates of tigecycline varied from 68% to 92%, except P. aeruginosa and P. mirabilis. However, the susceptibility rate for the same isolates remained within 58% to 90%, following EUCAST breakpoint. Conclusions: Tigecycline exhibited potent in vitro activity against Gram-negative carbapenemase producers, except P. aeruginosa and Proteus spp. Its broad-spectrum activity combining with stability against common resistance mechanisms and the lack of cross-resistance with other classes of antimicrobials make tigecycline a therapeutic agent for the multidrug-resistant microorganisms.
  797 22 -
Understanding the factors associated with nonreporting of needlestick injuries in nurses at Imam Khomeini Hospital Complex, Tehran 2016: A case study
Abolfazl Sobati, Reza Masoudi
May-June 2017, 10(3):651-656
DOI:10.4103/ATMPH.ATMPH_199_17  
Introduction: Needle in the body creates one of the potential problems which put people working in the health-care environment at risk of exposure to infection. The number of contaminated needlestick injuries among health-care workers as a result of underreporting of these injuries is unknown. The aim of this study is to investigate factors related to nurses reporting of needlestick in Imam Khomeini in Tehran. Materials and Methods: The present research method is a descriptive–analytic survey. The statistical population included all nurses in Tehran Imam Khomeini Hospital Complex consisting of three centers (Imam Khomeini Hospital, Vali-Asr, and Cancer Institute) in 2016. According to the Statistics center of Tehran University of Medical Sciences and Human Resources, on-duty nurses are 1100. Two hundred and eighty-five nurses stratified randomly sampling table and using Morgan were selected. To collect the data, in this study, a standard questionnaire reporting Azadi and Anoushe (2007) was used. Research data analysis, descriptive and inferential statistics were performed using SPSS software. Results: The results of descriptive statistics showed that 61.5 percent of nurses had experienced a needlestick exposure, while fending off contaminated needles has been the most frequent (RF = 61.5). Inferential statistical findings showed that the average area of individual and organizational affecting the reporting of needlestick respectively was 2.14 and 2.26. Also, there was a significant difference between individual and organizational factors affecting the reporting of needlestick injury based on education and work experience. Conclusion: The results of this study showed that contaminated needlestick injuries and underreporting of injuries among nurses include a high rate and larger studies need to be done in this regard. Interventions such as a standard protocol as well as reporting, staff training, and postexposure prophylactic standard treatments can be effective in improving the reporting percentage of these injuries.
  796 20 -
Analgesic effects of ketorolac/lidocaine compared to dexmedetomidine/lidocaine in intravenous regional anesthesia
Hesameddin Modir, Bijan Yazdi, Hushang Talebi, Majid Golestani Eraghi, Ahmadreza Behrouzi, Amirreza Modir
May-June 2017, 10(3):715-720
DOI:10.4103/ATMPH.ATMPH_263_17  
Introduction: Intravenous regional anesthesia is known as a safe and reliable technique for anesthesia and reduction of bleeding during limb surgeries. The aim of this study is to compare the addition of ketorolac or dexmedetomidine to lidocaine in intravenous regional anesthesia. Materials and Methods: In this double-blind clinical trial, ninety patients who were admitted for surgery on hand or forearm in Vali-Asr Hospital, Arak city, entered the study. Then, the patients divided into three equal groups. The first group received 3 mg/kg lidocaine 0.5%, the second group received 1 μg/kg dexmedetomidine with lidocaine, and the third group received 30 mg ketorolac with lidocaine. The time to analgesia, pain during surgery, onset of pain after tourniquet deflation, and the pain after tourniquet deflation were measured. Results: The mean duration to analgesia was 7.37 ± 0.67 min in control group, 5.23 ± 0.68 min in dexmedetomidine group, and 4.90 ± 0.76 min in ketorolac group (P = 0.164). In total of 3 times of measurement of pain after injection, the mean visual analog scale in ketorolac group was significantly lower than lidocaine (P = 0.0001) and dexmedetomidine (P = 0.009) groups. In all time intervals after tourniquet deflation, the mean score of pain was significantly lower in ketorolac group. Conclusion: Ketorolac could control the perioperative pain and the pain after tourniquet deflation. It seems that ketorolac is a useful and effective choice for pain relief for patients undergoing intravenous regional anesthesia.
  796 18 -
Relationship of strategies for emotion cognitive adjustment with psychological well-being and anxiety in mothers with cancer children
Abed Mahdavi, Mahjubeh Pahlevani, Maryam Aghaei, Vian Aminnasab, Hurieh Haji, Simin Gholamrezaei
May-June 2017, 10(3):702-706
DOI:10.4103/ATMPH.ATMPH_235_17  
Background and Purpose: The present study was aimed to examine the relationship between strategies of emotion cognitive adjustment and psychological well-being with anxiety in mothers with cancer children. Materials and Methods: The statistical population of the study consisted of 86 individuals, who were selected using convenience sampling method; they responded to psychological well-being and anxiety questionnaires. Results: The research method was descriptive of a correlational type. Data obtained from questionnaires were analyzed through multivariate regression in SPSS software, after being marked. Findings showed that there is a significant relationship between emotion cognitive adjustment strategies and anxiety and psychological well-being in mothers with cancer children. Conclusion: Results showed that emotion cognitive adjustment predicts about 27.1% of anxiety changes and about 26.8% of psychological well-being changes in mothers with cancer children.
  778 19 -
CASE REPORTS
Dengue encephalitis with cerebellar involvement: A rare case report
Munna Lal Patel, Radhey Shyam, Durgesh Kumar Pushkar, Rekha Sachan
May-June 2017, 10(3):734-736
DOI:10.4103/ATMPH.ATMPH_93_17  
Dengue is the most important arthropod-borne viral infection of humans. Clinical presentation of dengue fever ranged from mild clinical febrile illness to severe life-threatening conditions. Many unusual neurological manifestations have been reported with dengue fever. These include aseptic meningitis, encephalitis, myelitis, intracranial hemorrhage, and mono/polyneuropathies. Here, we report a case who presented with cerebellar syndrome with sinus bradycardia as the initial manifestation of dengue fever.
  769 18 -
LETTERS TO THE EDITOR
What could be done for prevention of Cholera: My suggestion is that individual health is much important for preventing the disease. Are you agreeing with me?
Ali Mehrabi Tavana
May-June 2017, 10(3):769-770
DOI:10.4103/1755-6783.196629  
  736 29 -
BRIEF REPORT
Atypical mycoplasma pneumoniae, Hepatitis A with extrapulmonary tuberculosis presenting as cold agglutinin
Majed Momin, Anamika Aluri, Abhijeet Ingle, C Sandhya Rani, Karishma Rosann Pereira
May-June 2017, 10(3):775-778
DOI:10.4103/1755-6783.213177  
Coexistence of atypical Mycoplasma pneumoniae, Hepatitis A with extrapulmonary tuberculosis in one patient presenting as cold agglutinin is rare. We report a case of 29-year-old male presenting with history of low grade fever, yellowish discoloration of eyes and pain in abdomen. On initial routine investigations diagnosed as pancytopenia, cold agglutinin disease, Hepatitis A, and Mycoplasma pneumoniae. Further investigation including bone marrow biopsy revealed granulomas and positron emission tomography-computed tomography showed tiny deep seated lymph node which on further excision confirms tuberculous lymphadenitis with positive acid fast bacillus. The patient responded well to treatment and recovered completely in due course of time.
  719 19 -
LETTERS TO THE EDITOR
Liver problem in zika virus infection: Possibility?
Beuy Joob, Viroj Wiwanitkit
May-June 2017, 10(3):751-752
DOI:10.4103/1755-6783.213134  
  718 18 -
After three decades of the chernobyl nuclear disaster: Where we are? What we have to focus upon?
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):753-754
DOI:10.4103/1755-6783.196850  
  701 24 -
EDITORIAL COMMENTARIES
Involving fathers in achieving gender equality through a television reality show
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):503-504
DOI:10.4103/1755-6783.213159  
  700 19 -
CASE REPORTS
The challenges of antenna modification in medical practice: The MRI machine
ME Emetere, ES Sanni
May-June 2017, 10(3):726-730
DOI:10.4103/ATMPH.ATMPH_558_16  
The challenges of modifying the antenna of imaging systems, e.g., MRI, are enormous. The electromagnetic principles for the non-ionizing radiation technique to view internal structures in the human body depend on many factors such as the ratings of the magnetic field, computer, digitizer, RF source, and electrical field. An incorporation of the Bloch NMR flow equation alongside the electromagnetic principles is quite complex. However, the modality was successfully developed to predict the radiofrequency appropriate for the successful imaging session. It was observed that the patient is currently under severe danger of excess exposure to electromagnetic fields.
  698 19 -
ORIGINAL ARTICLES
An evaluation of the effects of influenza vaccination on HIV/AIDS-stricken patients in Kermanshah Province, Western Iran
Mohammad Mehdi Gooya, Mahmoud Soroush, Nahid Khademi, Talat Mokhtari-Azad, Alireza Janbakhsh, Soliman Yeilaghi, Shahriar Parsa, Sharam Saeidi, Alireza Zangeneh
May-June 2017, 10(3):628-631
DOI:10.4103/ATMPH.ATMPH_117_17  
Background: Influenza is a contagious disease that runs a deteriorating and lethal course among high-risk groups such as HIV/AIDS patients. Influenza vaccination is significant among the high-risk groups, but there is inadequate information about vaccination among HIV/AIDS- patients. Objective: The aim of the study was investigating the effects of influenza vaccination on HIV/AIDS-stricken patients residing in Kermanshah Province, Western Iran. Materials and Methods: The present work was classified as a clinical trial. To perform the study, 134 HIV/AIDS-stricken patients were selected at the Counseling Center for Behavioral Disorders based in Kermanshah in 2014. The inclusion criteria were patients under antiretroviral treatment for at least 12 months' duration and availability of the participants in the study. 0.5 millimeters of influenza vaccine were injected into the deltoid muscles of the participants. One month before and after the injection, their blood samples were taken and stored at a temperature of –20 °C. The antibody titer tests were performed at the National Influenza Centre (NIC) based in Tehran, Iran, through the cold chain. After data collection, the SPSS Statistics 21 Software was utilized for data analysis. Results: In total 63.4% of the subjects were men and the rest (36.6) were women. The average age of the patients was 37.5 ± 8.5 years (men = 39.9±7.7 and women = 34±1.2). The results showed that the serum level of the anti-A (H1N1) antibody increased from 71.6% to 91.8% and that of the anti-B antibody went up from 70.1% to 92.5%. In addition, the results of t-test demonstrated that there was a significant difference between the levels of anti-B antibody titer and anti-A (H1N1) antibody titer before and after the influenza vaccination (P ≤ 0.05). Also, the means of CD4 and CI95% were significantly different before and after the injection (P ≤ 0.05). In this research, the CD4 count over 500 cells/mm3 rose from 22.2% to 32.8% before and after the vaccination, indicating a significant increase according to the t-test (P ≤ 0.05). Conclusion: From the presented, it can be concluded the CD4 count over 500 cells/mm3 increased after vaccination among HIV/AIDS-stricken patients. Therefore, the annual vaccination of HIV/AIDS-stricken patients against influenza can lessen the severity of pathogenicity, length of hospital stays, and mortality through stimulating the immune system and increasing the anti-Band anti-A (H1N1) antibody titers and CD4 cell counts.
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EDITORIAL COMMENTARIES
Strengthening research and development activities to effectively contain the epidemics of infectious diseases: World health organization
Saurabh R Shrivastava, Prateek S Shrivastava, Ramasamy Jegadeesh
May-June 2017, 10(3):499-500
DOI:10.4103/1755-6783.213157  
  673 18 -
Safe space: An effective option to ensure normalcy in the lives of refugee women and girls in conflict-affected Syria
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):501-502
DOI:10.4103/1755-6783.213158  
  661 18 -
Improving the drinking water supply universally and bridging the existing gaps
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):529-530
DOI:10.4103/1755-6783.196829  
  637 38 -
ORIGINAL ARTICLES
Determination of the air pollution index of atmospheric air in Aktobe
Ludmila S Yermukhanova, S Urazaeva, M Artukbaeva, K Azhenova, M Almakhanova, A Zhaubassova, AK Mukyshova
May-June 2017, 10(3):664-666
DOI:10.4103/ATMPH.ATMPH_209_17  
Aim: The purpose of this study is to determine the air pollution index of the micro territories of Aktobe. An aerogenic ingress of the xenobiotics is the foreground among the environmental factors for urban areas. In this regard, monitoring the state of the atmosphere of cities to establish quantitative regularities of risk for the health and development of the managerial decisions on their basis should be classified as priority hygiene problems. Material and Methods: Determination of API was performed based on data obtained by three stationary atmosphere state observation points of hydrometeorological center, located on the industrial area at a distance, respectively: point 1 (VI, VII microterritories) - 18 km; Point 2 (IV, V microterritories) - 12 km; and Point 3 (I, II, III microterritories) - 3 km. Atmospheric pollution index was calculated for the five substances with the highest values. The calculation was based on the content of following elements in the urban-industrial environment: iron, manganese, hexavalent chromium, magnesium, and vanadium which possess the immunotropic action. Results and Discussion: The results obtained by calculation of API show that the highest pollution index is observed at point that is 1.6 times greater than in the first observation point and 1.8 times in the second observation point. This is explained by the fact that the inhabitants of I, II, and III microterritories are the closest to the industrial zone and the most exposed to harmful air substances. Conclusion: This is explained by the fact that the inhabitants of I, II, and III microterritories are the closest to the industrial zone and the most exposed to harmful air substances.
  656 18 -
LETTERS TO THE EDITOR
Network creation to support the international collaboration: A short note on Surindra – Niigata University relationship
Atchara Phanurat, Wasana Kaewla, Viroj Wiwanitkit
May-June 2017, 10(3):738-739
DOI:10.4103/ATMPH.ATMPH_154_15  
  655 18 -
EDITORIAL COMMENTARIES
Sexual and reproductive health needs of women and girls: Determinants, utilization, and role of adolescent peer educators
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):519-520
DOI:10.4103/1755-6783.213167  
  646 18 -
ORIGINAL ARTICLES
The study of hemodialysis on the change rate of serum L-creatinine and lipid peroxidation levels
Lida Haghnazari, Hamid Nomani, Asad Vaisi-Raygani, Maryam Esfahani, Sahar Foroughinia
May-June 2017, 10(3):623-627
DOI:10.4103/ATMPH.ATMPH_113_17  
Background: Chronic renal failure (CRF) is one of the most prevalent diseases of human societies, especially in Iran. Despite all advances that have been made so far, hemodialysis with all its complications is being applied as the novel treatment strategy for such individuals. Objective: The aim of this study is to investigate the effect of hemodialysis on the change rate of serum L-creatinine and lipid peroxidation levels. Materials and Methods: This study is an analytical research which used a convenience sampling method. Malondialdehyde (MDA) as the indicator of lipid peroxidation and L-creatinine was measured in 27 patients (17 males and 10 females). Malondialdehyde was calculated using the standard thiobarbituric acid (TBA) method and L-creatinine through the t-test enzymatic method (Roche kit) (SpectronicGenesys 340 nm). Results: The mean and standard deviation of serum L-creatinine before and after dialysis was 7.67 ± 3.6 mg/L and 2.07 ± 1.6 mg/L, respectively (P < 0.001). The MDA mean of serum before and afterdialysis was 4.17 ± 1.24 mol/L and 4.98 ± 1.2 mol/L, respectively (P < 0.001). Conclusion: Analyses show that serum L-creatinine reduces considerably after dialysis. In addition, the results suggest that stress oxidative reduces following hemodialysis in these patients, which is observed in the form of the increased lipid peroxidation.
  642 19 -
LETTERS TO THE EDITOR
What can we learn from Google Map base GIS system on opisthorchiasis in northeastern Thailand?
Sora Yasri, Viroj Wiwanitkit
May-June 2017, 10(3):758-759
DOI:10.4103/1755-6783.196599  
  625 27 -
EDITORIAL COMMENTARIES
INSPIRE: A comprehensive package to reduce violence against children and provide a safe and nurturing environment
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):507-508
DOI:10.4103/1755-6783.213161  
  618 18 -
LETTERS TO THE EDITOR
How can we eradicate informal payments for health care in Asia?
Mohammad Meskarpour-Amiri, Abbas Assari, Hosein Sadeghi, Lotfali Agheli
May-June 2017, 10(3):771-772
DOI:10.4103/1755-6783.213154  
  616 18 -
Responding to the challenge of rising air pollution levels in world's poorest cities
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):756-757
DOI:10.4103/1755-6783.196598  
  595 23 -
Passing of Worm in Vomitus – A reliable history for diagnosis, when a patient complains for passing of worm in stool: How about the reliabilityxs?
Won Sriwijitalai, Viroj Wiwanitkit
May-June 2017, 10(3):767-767
DOI:10.4103/1755-6783.196600  
  594 23 -
Emergency contraception in a public health emergency “Zika virus outbreak”
Beuy Joob, Viroj Wiwanitkit
May-June 2017, 10(3):748-748
DOI:10.4103/1755-6783.213131  
  583 18 -
EDITORIAL COMMENTARIES
Social and health inequalities augment the incidence of Zika virus disease and its after effects
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):521-522
DOI:10.4103/1755-6783.213168  
  569 18 -
Challenges in HIV care: Accelerating the pace of HIV-related services to accomplish the set global targets
Saurabh RamBihariLal Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):509-510
DOI:10.4103/1755-6783.213162  
  554 18 -
Legal protection for women in Yemen: A sorry state
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):513-514
DOI:10.4103/1755-6783.213164  
  540 18 -
Yellow fever outbreak in Angola: The potential global threat and the prevailing challenges in the control of the disease
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):523-524
DOI:10.4103/1755-6783.213169  
  528 18 -
Census: A systematic and comprehensive tool to address the needs of the disadvantaged population groups
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):511-512
DOI:10.4103/1755-6783.213163  
  515 18 -
Employing mobile applications to improve the outcomes of adolescent's pregnancy
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):517-518
DOI:10.4103/1755-6783.213166  
  512 18 -
Accomplishing mother-to-child elimination of human immunodeficiency and syphilis: A remarkable achievement and a ray of hope for other nations
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):531-532
DOI:10.4103/1755-6783.196490  
  502 18 -
Promoting, protecting and supporting breastfeeding for ensuring sustainable development
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):525-526
DOI:10.4103/1755-6783.213170  
  491 18 -
LETTERS TO THE EDITOR
Traditional asian facial decoration: Its usefulness in mosquito prevention
Viroj Wiwanitkit
May-June 2017, 10(3):745-746
DOI:10.4103/1755-6783.213130  
  476 18 -
EDITORIAL COMMENTARIES
Anticipated shortage of benzathine penicillin: A threat to the ongoing global commitment for elimination of mother-to-child transmission of syphilis
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):515-516
DOI:10.4103/1755-6783.213165  
  475 18 -
LETTERS TO THE EDITOR
Contour, texture and color of intestinal parasite egg, Which can be useful in differential diagnosis
Viroj Wiwanitkit
May-June 2017, 10(3):748-749
DOI:10.4103/1755-6783.213132  
  474 18 -
Cat inside the airport: Public health issue?
Wasana Kaewla, Viroj Wiwanitkit
May-June 2017, 10(3):750-751
DOI:10.4103/1755-6783.213133  
  472 18 -
Dengue viremia in blood donors and what to be expected in cases of zika virus
Beuy Joob, Viroj Wiwanitkit
May-June 2017, 10(3):742-743
DOI:10.4103/1755-6783.213128  
  469 19 -
”Home-Temple-School-Public Health Unit” model: A case study of setting a primary public health and natural medicine center in rural community Thailand
Viroj Wiwanitkit, Wasana Kaewla, Suphattra Wpatcha
May-June 2017, 10(3):768-769
DOI:10.4103/1755-6783.213150  
  455 18 -
Can nocardiosis be isolated from ear discharge of otitis media patients? Yes or no
Tavana Ali
May-June 2017, 10(3):770-771
DOI:10.4103/1755-6783.213153  
  454 18 -
EDITORIAL COMMENTARIES
Aiming to target gender barriers for improving the health and welfare standards of girls
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):527-528
DOI:10.4103/1755-6783.213171  
  452 18 -
LETTERS TO THE EDITOR
Past oral care for management of public health crisis: A history analysis of ancient historical Thai case
Viroj Wiwanitkit
May-June 2017, 10(3):744-745
DOI:10.4103/1755-6783.213129  
  445 18 -
Increase in average life expectancy and the need to strengthen the monitoring process to track the progress of Sustainable Development Goals
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):765-766
DOI:10.4103/1755-6783.213141  
  441 18 -
Potential risk of Zika virus outbreak in the European region: Public health alert
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-June 2017, 10(3):764-765
DOI:10.4103/1755-6783.213140  
  438 18 -
Medical malacology and medical ichthyology survey: Can explain the situation of opisthorchiasis and cholangiocarcinoma in the endemic area or not? A comment from Thailand
Viroj Wiwanitkit
May-June 2017, 10(3):772-773
DOI:10.4103/1755-6783.213155  
  437 18 -
Expected risk of Zika virus infection for foreign visitors to the 2016 Summer Olympic Games in Brazil
Beuy Joob, Viroj Wiwanikit
May-June 2017, 10(3):774-774
DOI:10.4103/1755-6783.213156  
  432 18 -
Prenatal MRI in Zika Virus Infection
Viroj Wiwanitkit
May-June 2017, 10(3):755-756
DOI:10.4103/1755-6783.213138  
  425 18 -
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