Shiraz Namazi Hospital Research Articles

Inter- and intra-observer reliability of the Ergonomic Screening and Prioritization Tool to assess the risk level of work-related musculoskeletal disorders in nurses

Introduction: Musculoskeletal Disorders (MSDs) are among the most common occupational diseases, and ergonomics and occupational health engineering specialists need reliable and valid methods for assessing high-risk activities and the factors contributing to their occurrence. Materials and Methods: In this cross-sectional study, 100 nurses employed at Namazi Hospital in Shiraz were randomly selected. Data was collected using a demographic/occupational questionnaire, Hierarchical Task Analysis (HTA), and the Ergonomics Screening and Prioritizing Tool (ESPT). Three observers simultaneously assessed the risk of developing MSDs for each job duty. After a six-month interval, the same observers re-evaluated the same group of nurses in the same work Postures. To assess the reliability of ESPT between and within observers, the Intra-class Correlation Coefficient (ICC) and the Kappa Multi-rater Fleiss method were used. Data analysis was conducted using SPSS software version 26. Results: The results of the study showed a high agreement between each observer as well as between the three observers before and after six months. The ICC for observers 1, 2, and 3 were respectively 0.951, 0.947, and 0.927, and also between each of the three observers for the first and second time respectively 0.955 and 0.941. Conclusion: The ESPT has been shown to possess high reliability for assessing the risk of developing MSDs among nurses, and it can be used for this purpose.

Determination of Serum Procalcitonin Level in Kawasaki Disease

Background: The most frequent cause of coronary artery aneurysm in children is Kawasaki disease (KD). Recently, limited studies on procalcitonin (PCT) were performed to find a biomarker for the diagnosis or prognosis of children with KD. Objectives: This study aimed to compare serum PCT levels between complete and incomplete KD and testify to the predictive validity of PCT for intravenous immunoglobulin (IVIG) resistance and predicting coronary artery lesions (CALs). Methods: This cross-sectional study was conducted at Namazi hospital in Shiraz, Iran, in 2019. All KD patients admitted to the hospital were included, with parental consent obtained. Kawasaki disease patients were categorized as complete KD (cKD) or incomplete KD (iKD). Two-dimensional echocardiography was performed, and peripheral venous blood was examined for PCT levels and other markers. All patients received IVIG and aspirin as standard treatment. The presence of coronary artery abnormalities (CAAs) was determined based on coronary artery size and morphology. We used Stata software version 14.0 for data analysis. Logistic regression models identified predictive factors for coronary complications. This study determined the optimal PCT cut-off point for predicted coronary complications using receiver operating characteristic (ROC) curve analysis. Approval was obtained from the Research Ethics Committees of Shiraz University of Medical Sciences. Results: Procalcitonin values in 38 children hospitalized with acute KD ranged from 0.2 ng/mL to 10 ng/mL, with a mean of 2.65 ng/m. There was no correlation of PCT with patients’ age or gender, incomplete KD, or IVIG resistance. The serum PCT concentration was higher in patients with CAL (P = 0.009). The best PCT cut-off value for CAL prediction was 2.5 ng/mL (corresponding sensitivity = 81.8% and specificity = 68.7%), considering CAL prevalence as the studied group. Conclusions: Supplementary research is needed to determine the sensitivity and specificity of PCT for the diagnosis and prognosis of KD. Procalcitonin might be of value in predicting which children are at increased risk for CALs to intensify therapy.

Extraction of effective cycles on reducing patients’ depression in the design of treatment spaces

PurposeThe most common reaction to an acute physical illness is anxiety, which may be followed by depression. In patients with chronic diseases, the prevalence of anxiety disorders and depression is almost twice as high as in other diseases. This study aims to extract prominent components in the design of treatment spaces on reducing hospitalized patients’ depression from both experts and patients/users’ point of views. A final model is also presented based on the findings.Design/methodology/approachThis research used an exploratory mixed method. The effective components were extracted through the administration of two Likert-scale researcher-made questionnaires in two phases. Q factor analysis was conducted to reach the components. A total of 205 patients were admitted to Namazi Hospital in Shiraz, and 20 architecture and psychology experts participated in the survey. Final modeling of the data was done through path analysis.FindingsSix factors were found to be effective by experts in reducing depression in therapeutic spaces: nature-oriented space, targeted social space, diverse space, visual comfort, logical process and safe space. On the part of patients, seven components were deemed to be effective: visual perception, naturalism, functionalism, physical security, logical process, psychological safety and diversity. Also, four main cycles were extracted from the final model with the direct effect of diversity and the other five cycles were mediated by naturalism.Research limitations/implicationsA total of 15 interviews with architects and psychologists, who were available at the time of the study, were conducted in January 2018. The only general question during interviews was “In your opinion, what factors are effective in reducing the level of depression of patients in the design of treatment spaces?” This may have limited the range of factors that could be surveyed in the study. After collecting the effective factors from the aforementioned expert’s points of view, the questionnaire of experts was designed (Appendix). The expert questionnaires were distributed and edited in two stages in January 2019 among 20 architect experts who were available at the time of the study. The one-year interval between designing and administering the questionnaires occurred because of the limitations posed by the COVID-19 pandemic situation. However, the interval did not pose methodological obstacles for the study.Originality/valueEvidence-based investigation of the effectiveness of proper design components of therapeutic spaces in reducing the symptoms of patients with chronic secondary depression has received little attention in the literature. Using a “conceptual model,” the present study brought the issue into its focus so as to find effective components in the design of treatment spaces that can alleviate depression symptoms in chronically hospitalized patients.

Drug Utilization Evaluation of Erythropoietin at a Referral Teaching Hospital in Iran.

Drug utilization evaluation (DUE) studies aim to survey the appropriateness of drug use. DUE is an executive approach used to improve the use of medications as well as reduce the cost of treatment, ensure drug adequacy, and improve patient safety. The aim of this study was to evaluate the pattern of erythropoietin use, according to standard guidelines, in patients admitted to Namazi Hospital in Shiraz, Iran. In this descriptive, retrospective study, 230 patients were assessed. All patients who were hospitalized in different wards of Namazi Hospital, affiliated to Shiraz University of Medical Sciences, and received at least three doses of erythropoietin from September 2019 to March 2020 participated in this study. The following standard indicators of erythropoietin use were evaluated through reviewing medical charts of the cohort: drug dose, dosing intervals, route of administration, indication, monitoring of laboratory parameters, drug dose adjustment based on the response rate as well as target hemoglobin ≥12 g/dl, attention to major drug interactions, and administration of injectable or oral iron supplementation during treatment. Most (65.2%) of the participants were male. The mean ± SD age of the patients was 47.55 ± 22.71 years. More than half (51.3%) of the included subjects were hospitalized in the nephrology ward. PDpoetin® and Cinnapoietin® were given to 52.6% and 47.4% of the study participants, respectively. Treatment of anemia due to chronic kidney disease was the most frequent indication of erythropoietin. The time interval of erythropoietin administration was three times a week for 68.3% of the patients. The most frequently administered weekly dose of erythropoietin was 12,000 units. The weekly dose, dose interval, and route of administration of erythropoietin were appropriate in 52.6%, 77.4%, and 100% of the patients, respectively. Dose adjustment based on the response rate, attention to major drug interactions as well as absolute-relative contraindications, and attention to the target hemoglobin ≥12 g/dl to decide whether or not to continue treatment were based on standard guideline in 98.1%, 98.7%, and 93% of the patients, respectively. The sum indexes of erythropoietin use were in line with standard guidelines in 75.84% of the cases. According to our results, in the setting of erythropoietin use in hospitals, physicians need more attention and education in areas such as selecting the proper dose of medication, correct indication of the drug, temporal arrangement of monitoring laboratory items, and the patient's need for iron supplements.

Unnecessary Brain CT Scan and MRI Prescriptions for Evaluation of Children Suffering from Headache Referring to Namazi Hospital of Shiraz

Background and Objectives Despite the significant role of brain magnetic resonance imaging (MRI) and computed tomography (CT) scans in diagnosing diseases, unnecessary prescriptions of these imaging techniques may lead to adverse consequences, imposing a heavy financial burden on patients and health systems. The present study aimed to assess the unnecessary use of imaging services for the evaluation of children suffering from headaches in Namazi Hospital in Shiraz in 2020.. Subjects and Methods The research population of this retrospective study included all children who were referred to Namazi Hospital with the chief complaint of headache in 2019. Since the research sample was equal to the research population, no sampling was performed, and all individuals were surveyed through the census method. The data were analyzed in SPSS software (version 19) using statistical methods. Results Of the 54 brain MRIs performed, 7.4% were necessary, and 92.5% were unnecessary. Moreover, regarding 81 brain CT scans performed, 8.6% were necessary and 91.3% were not. The indication and insurance status had a significant positive relationship with the necessity of brain MRI and CT scan prescriptions (P<0.05). The total financial burden imposed by unnecessary brain MRIs and brain CT scans of the studied patients in Shiraz Namazi Hospital was 158,298,588 Iranian Rials in 2020. Conclusion The results pointed out that over 90% of the brain MRIs and CT scans prescribed for children with headaches were unnecessary, which could impose unnecessary patient costs. Therefore, it seems essential to use effective clinical guidelines for the proper administration of brain MRI and CT scans.

Compliance with standard precautions, sharp injuries, and blood and body fluid exposure among healthcare workers

Background & Aim: Healthcare workers are exposed to certain infectious diseases through needlestick injuries and exposure to blood and other bodily fluids. This study aimed to determine the prevalence of needlestick injuries and blood and other body fluids exposure among healthcare workers at Namazi Hospital in Shiraz, Iran.
 Methods & Materials: This cross-sectional study was conducted on 656 Healthcare workers, including students and staff in medical, nursing, laboratory, service, and operating room groups, at the Namazi Hospital, in 2019. A questionnaire with four parts, including demographics, questions about using sharps containers, needle recapping, masks, and glasses, and the experience of sharps injuries or blood and body fluid exposure and reporting them, was distributed using the quota sampling method. To analyze the results, the T‑test and Chi-square test were performed.
 Results: Nearly 75.2% of the participants always used sharps containers, and 21.7% never recapped syringes. Sharps injuries and blood and body fluid exposure occurred in 40.7% and 39.8% of the participants. Occupation (P<0.001), being a student (P: 0.048), and age (P: 0.008) were associated with sharp injuries. Occupation (P: 0.001), gender (P: 0.016), and age (P<0.001) differed in exposed and no exposed participants to blood and body fluids. The prevalence of reporting exposure was not significantly different between men and women, occupation groups, students and staff, and different ages (P> 0.05).
 Conclusion: Hospital managers should provide effective educational interventions to protect against occupational hazard exposures. Also, they should provide protective equipment for Healthcare workers.

Iranian stroke model-how to involve health policymakers

Iranian stroke model-how to involve health policymakers

Comparative assessment of the mouse immune responses to colistin-resistant and colistin-sensitive isolates of Acinetobacter baumannii

Acinetobacter baumannii is known as the most frequent species in clinical samples that is responsible for a large number of nosocomial infection outbreaks. The colistin-resistance of this bacterium has been found to be increasing. This study aimed to evaluate the immune response to colistin-susceptible and colistin-resistant A. baumannii isolates in a mouse model. Samples were prepared from the wounds of patients suspected of A. baumannii admitted to the intensive care unit of Namazi Hospital in Shiraz. Antibiotic susceptibility was studied by disk diffusion and broth microdilution according to CLSI and EUCAST criteria. Among the isolates, one colistin-sensitive isolate and one colistin-resistant isolate were injected intraperitoneally to BALB/C mice. Blood samples were collected after 4 h and cytokines (IL1-β, IL-12, IFN γ, and IL-10) and surface markers (CD4, CD8, CD3, and CD45) were determined by ELISA and flow cytometry. Then, hematologic and histopathological factors were analyzed, and colony count in lung, liver, kidney, and spleen tissues were also performed. The results showed that levels of cytokines (IL1-β, IL-12, IFN γ, and IL-10) and markers (CD4, CD8, CD3 and CD45) were higher in mice receiving colistin-resistant A. baumannii isolates than in mice receiving colistin-sensitive A. baumannii isolates, indicating that colistin-resistant isolates 4 h following the intraperitoneal injection stimulated host innate immune system better and produced a stronger immune response. On the other hand, histopathological findings showed inflammatory cell infiltration, hyperemia, and tissue damage. In addition, the bacterial load and tissue damage in the lung was higher than other tissues. The results of this study can have promising potential for the development of a prevention and treatment strategy based on cellular immune response for infection caused by colistin-sensitive and colistin-resistant A. baumannii.

Emergence of OXA-10 and OXA-48 Like Carbapenemases among Enterobacter Isolates from Inpatients in Namazi Hospital in Shiraz

Emergence of OXA-10 and OXA-48 Like Carbapenemases among Enterobacter Isolates from Inpatients in Namazi Hospital in Shiraz

The Effect of Loyalty to, Confidence in and Emotional Commitment to Brand Regarding Brand Advocacy in Shiraz Namazi Hospital

Background: Brand can impart a unique meaning of the organization to consumers and create many comparative advantages. This relationship is created through trust, connection, loyalty and emotional commitment to the brand and their impact on advocacy and the development of emotional relationships between the customer and the organization. The aim of this study was to investigate the effect of loyalty to, confidence in and emotional commitment to brand regarding brand advocacy.
 Methods: This research was applied in terms of purpose and descriptive-survey in terms of data collection method. Data collection tool was a researcher-made questionnaire whose face validity was confirmed by professors and experts. Convergent validity with a mean variance of more than 0.5 and divergent validity using Fornell and Larker methods were confirmed. Also, the reliability of the instrument was confirmed with the Cronbach's alpha of more than 0.7. The statistical population was patients of Shiraz Namazi Hospital in 2020. After conducting a pre-test and confirming the validity and reliability and determining the variance deviation of the prototype, using Cochran's formula, the statistical sample size was determined to be 300. The final questionnaires were distributed and collected among patients through convenience sampling method. Finally, after data analysis, the conceptual model of the research was fitted using the structural equation model and PLS3 software.
 Results: The conceptual model of the research was fitted using various indicators and the results showed that the model has appropriate quality and acceptable validity. Quantitatively, findings indicated that brand confidence of 0.228 had a significant effect on brand advocacy, but emotional commitment and loyalty with a coefficient of 0.049 and 0.007, respectively, had no significant effect on brand advocacy.
 Conclusion: Results suggest that brand confidence is achieved by patients through perceived quality, brand credibility and customer-oriented behavior of the hospital staff. Moreover, the influence of reference groups and the social responsibility on the hospital, with the help of confidence in brand, creates emotional commitment in patients.

ABO blood group and Rh factor distributions in patients with epilepsy

ObjectiveWe investigated the ABO blood group and Rh factor distributions in patients with epilepsy (PWE) in comparison with a comparator population. MethodsWe recruited patients who were admitted to the epilepsy ward at Namazi hospital in Shiraz, Iran, in 2021. We classified epilepsies into two categories: focal vs. generalized. We also used the anonymous data from Fars Blood Transfusion Organization from 15th June to 30th June, 2021, as the comparator population (to estimate the frequencies of various blood types in the cohort from which PWE were recruited). ResultsOverall, 390 PWE were included [131 (33.6%) with generalized and 259 (66.4%) with focal epilepsy]. We also included 7672 blood donors [from Fars Blood Transfusion Organization data]. The O phenotype had the highest frequencies in both PWE and the comparator population, followed by A, B, and AB blood groups. Similar patterns were observed in patients with focal and generalized epilepsy. With regard to Rh blood group, the Rh-positive phenotype was more prevalent in all groups. The differences between the groups were not significant in any of the comparisons. ConclusionWhile we did not observe any significant associations between blood group and epilepsy in the current study, previous studies have demonstrated compelling evidence that risks of some neuropsychiatric disorders are related to the chemistry of blood, including blood group classification. The issue of the association between epilepsy and blood group should be investigated in large and well-designed studies in the future.

Cost-Effectiveness of Osteoporosis Screening in Women Over 40-Year-Old

Osteoporosis is a disease recognized by bone density reduction and is particularly common among older women, which imposes them to fractures. The evidence shows that if do no serious conflict with this issue, in the far little future, huge costs will be imposed on individuals, families, and the country. In this study, we studied the cost-effectiveness of osteoporosis screening in women over 40 years of age in Shiraz in 2016. This cross-sectional study was performed on 240 persons who were screened and 240 non-screened persons in the bone mineral density ward of Shiraz Namazi Hospital. The costs were identified and from the perspective of the insurer and the payer, which included only direct health care costs. To measure the effectiveness, the use of indicators as quality-adjusted life-years (QALY), the expected cost and effectiveness, and the Incremental cost-effectiveness ratio were calculated. The results showed that non-screening is the best strategy, given that the amount of ICER was obtained at $38484.56 and the threshold. As a result, the non-screening method compared to screening is cost-effective. The relevant authorities and proficients should prevent the progression of disease complications and consequently prevent the increase of the disease cost and improve the quality of life of the patients.

يافته هاي الكتروكارديوگرافي مرتبط با ايسكمي ميوكارد در بيماران با علايم غير قلبي مراجعه كننده به اورژانس نمازي در سال 1397

Introduction: Silent myocardial ischemia is defined as the presence of objective evidence of cardiac ischemia in the absence of chest discomfort or one of the symptoms equivalent to angina. The aim of this study was to evaluate the electrocardiography (ECG) findings related to cardiac ischemia in non-cardiac patients with suspected silent myocardial ischemia referring to the emergency department. Methods: This retrospective cross-sectional study (March 2018-March 2019) was conducted on adult patients with non-cardiac complaints referring to the Emergency Department of Shiraz Namazi Hospital, southern Iran, with triage levels 1 and 2, who were suspected to have silent myocardial ischemia, and underwent ECG and two troponin tests after admission. Patients with trauma, triage levels 3-5, those with typical chest pain, and patients with diagnosis of ST-Elevation Myocardial Infarction (STEMI) were excluded from the survey. Demographic data, the results of two troponin tests, and cardiac ischemia-related findings on ECG, including ST depression and T inversion, were evaluated. Then, the data were statistically analyzed using SPSS version 16 and descriptive and analytical statistical tests. Results: Overall, 180 patients were enrolled. The mean (± standard deviation) of patients’ age was 69.3±15.01 years. 92 patients (51.1%) were male. ST depression and T inversion were found in ECG of 90 (50.0%) and 88 (48.9%) patients, respectively. ST depression and/or T inversion was observed in 168 (93.3%) patients. There was no statistically significant relationship between mean age, gender, and cause of referral with ST depression or T inversion. Two positive troponin test results were observed in 23 (12.8%) and both tests were negative in 59.4% of patients. There was no statistically significant relationship between having at least one positive troponin test and having ST depression or T inversion findings (P-value=0.56 and P-value=0.90, respectively). Conclusion: ST depression and T inversion were present in ECG of half of the patients. Two positive troponin and both negative tests were observed in 23 (12.8%) and 59.4% of patients, respectively. This finding indicates that the matching of ECG findings and multistage troponin test is great important in the final diagnosis of cardiac ischemia, however, ECG changes in patients with non-cardiac complaints do not necessarily is indicated the myocardial infarction.

Development of Minimum Data Set for Electronic Documentation of Progress Note in the General Intensive Care Unit

Introduction: Electronic documentation in the intensive care unit (ICU) has a significant effect on the quality of data. In addition, using structured data and standard formats can facilitate documentation of progress note data. Therefore, the aim of this study was to create a minimum data set for an effective design and implementation of electronic documentation of progress note in the ICU.Material and Methods: This is an applied qualitative study conducted in the general intensive care unit of Namazi Hospital in Shiraz, which is the largest education and treatment center in Shiraz and the only referral hospital in Southern Iran. In this study, four stages were used for designing the minimum data sets of electronic progress note: 1. Using English literature, 2. Local expert review, 3. Designing prototypes, and 4. Conducting group sessions. Finally, at the quantitative stage of the study, the data were analyzed using descriptive statistics (frequency and percentage) through SPSS 21 software.Results: The minimum data set for electronic documentation of progress note in the ICU included the two demographic and clinical sections. In addition, the clinical data were classified into 11 major groups, each consisting of other items. Meanwhile, 46.8% (66 out of 141) of information items were obtained from reviewing the literature and 53.2% (76 out of 141) from interviews. In group sessions, 99.29% of information items were finalized by experts.Conclusion: it is essential to create a standard and structured minimum data set for the electronic design and implementation of progress note data. In such a case, accurate, thorough and timely electronic documentation in presenting instantaneous reports on the status of patients is effective in management and clinical decision-makings.

The prevalence of ESBL and AmpC β-lactamases in uropathogenic isolates of Escherichia coli in a tertiary care hospital in Southwest Iran

The aim of this study is to determine the molecular detection of AmpC β-lactamases (AmpC) and ESBLs, among clinical E. coli isolated from Namazi hospital in Shiraz, Iran. A total of 177 isolates from inpatients with UTI from different wards were identified as UPEC using the conventional microbiological tests. Phenotypic detection of ESBLs and Amp-C-β lactamase (Amp-C) production was done by various combinations of disc diffusion methods, followed by polymerase-chain-reaction for the detection of Amp-C and β-lactamase-encoding genes. The analysis showed that 46.3% of the isolates were ESBLs positive and that fifteen strains revealed the AmpC cluster genes. Among all ESBL-positive E. coli isolates, the CTX-M was the most prevalent ESBL type (68.2%), and in AmpC-positive isolates, fifteen isolates (88.2%) were positive for CITM cluster gene and two (11.7%) were positive for DHAM cluster gene. ACCM, FOXM, EBCM and MOXM cluster genes were not found in this study. Our findings revealed that the prevalence of AmpC β-lactamases is rising in Iran, leading to failure in treatment. Therefore, the current study recommended that accurate and precise methods and guidelines should be designed for detection of antibiotic-resistant mechanisms because it is very important for the treatment and prevention of such isolates.

The Comparison of the Analgesic Effect of Intravenous Acetaminophen with Fentanyl in Thoracic and Abdominal Surgeries of Newborns

Background The use of opioid drugs for controlling pain during and after surgery is a common but complicated procedure in neonatal anesthesia. This study compared the analgesic effect of acetaminophen with fentanyl after abdominal and chest surgery in Iranian newborns. Materials and Methods This randomized, double-blind clinical trial was conducted in two hospitals; in the NICU of Shahid Motahari hospital in Urmia and Namazi hospital in Shiraz, Iran. Sixty-six patients were randomized sequentially and assigned in two groups. One group of patients received acetaminophen dose of 10 mg/kg every six hours, and another group received fentanyl 6 µg/Kg every six hours for 48 hours (9 doses). For all patients, pain was assessed using the Neonatal Infant Pain Scale (NIPS) at first time, 6, 12, 18, 24, 30, 36, 42 and 48 hours (9 measurements). If necessary, fentanyl 1 µg/Kg was injected to the patients. Finally, all the information was recorded and analyzed using SPSS software (version 21.0). Results The mean age of the fentanyl group was 16.79 ± 15.57 days and 16.67 ± 15.77 days in the acetaminophen group (P>0.05). The mean weight in the fentanyl group was 3460 ± 737 gr and in the acetaminophen group was 3228.548 ± 32.28 gr (P>0.05). Results showed that the mean scores of pain in all periods of time were not significantly different between the two groups (P>0.05). No drug complications were seen in the acetaminophen group. Conclusion Based on the results, mean score of pain in fentanyl and acetaminophen groups was not statistically significant. Acetaminophen did not control pain as well as fentanyl in neonatal surgeries.

Hadron Therapy in Iran: Patient Indication Estimation and Challenges Ahead

Introduction: Radiotherapy with heavy charged particles such as protons and carbon ions (hadron therapy) has been recognized as an advanced technique for the treatment of various cancers. For some indications such as pediatric and radio-resistant tumors, it is considered the preferred method. However, despite its remarkable benefits, development of hadron therapy centers in the world has always been subject to major constraints due to a number of reasons including the high costs of constructing and maintaining the centers, the need for strong infrastructures, and the lack of adequate research on the estimation of the number of patients eligible for utilizing this technique. Therefore, this study aimed to investigate the initial estimation of the number of patients eligible for hadron therapy in the Fars Province and Iran as a whole. Materials and Methods: In the absence of comprehensive national cancer registry data, the information for the initial estimation of the number of patients residing in the province were collected from the medical records of the patients who were treated at the Radiotherapy Department of Shiraz Namazi Hospital in 2014. First, the patients’ demographic data (place of residence, age, and sex) as well as the type of cancer were extracted according to the patients’ pathology reports. Only the patients residing in Fars were selected. Then, all of the resulting indications were classified based on the methodology proposed in previous studies, and by applying separate coefficients on each, all the indications suitable for the hadron therapy in Fars were determined. Subsequently, by applying a coefficient of 16.4 (the ratio of the total population of the country to that of the Fars Province in 2014), the number of the patients eligible for hadron therapy in the whole country was calculated. Results: Of the total 2,932 cases studied, 1536 patients were residing in Fars, 22.9% of whom were eligible for hadron therapy. Accordingly, the total number of patients in the country was estimated to be 5765 cases/year. Considering similar studies from other countries with such clinics, at least two hadron therapy centers are needed for treating the eligible estimated population. Conclusion: The analysis performed in this study (solely considering patient numbers and treatment indications) suggests that at least two geographically-spread hadron therapy centers are indicated (covering two northern and southern regions of similar populations). The limitations in having access to accurate patient data and the insufficiencies in the national cancer registry system hinders accurate estimations, which potentially lead to underestimation of patient numbers. Also, other economic factors, experience of other countries and expert advice should be considered. The need for extensive cost-benefit studies versus lower-cost radiotherapy equipment before investment is emphasized.

Inter-observer agreement on varicoceles diagnosis among patients referred to Shiraz Namazi Hospital

Varicocele is the collection of dilated veins of pampiniform plexus which is the most common cause of infertility occurred in 35-40% of infertile men. Despite all the diagnostic tools exist for varicocele diagnosis; still, a physical examination is the first step. This study was done to determine the inter-observer agreement on varicoceles diagnosis. In this cross-sectional study, two expert examiners evaluated 93 men with infertility, scrotal pain, and enlarged scrotum for the presence of varicocele. The urologists examined patients independently in two separate rooms. The inter-observer agreement on varicocele grading analyzed by the Spearman Rho correlation coefficient. The grading of varicocele were similar in 34 (36.5%) and 59 (63.4%) cases in the left and right side, respectively with correlation coefficient of 0.65 (0.51-0.75) and 0.25 (0.04-0.43), respectively. It implies that inter-observer agreement was substantial for left varicocele assessment and moderate for right varicocele assessment. Physical exam is the essential diagnostic tool for varicocele. As long as the observers educated with the same standard method the disagreements reduced to the negligible extent.

Current Challenges of Kidney Transplantation in Iran: Moving Beyond The "Iranian Model".

Organ Transplantation in Iran has come a long way with many different policies and approaches addressing demand and supply. The first successfully kidney transplantation was performed at Namazi Hospital in Shiraz from a living donor in 1967. However, there had been only limited transplant activities in Iran until mid-1970. Previously, patients compensated the lack of organ transplants in Iran by travelling outside the country including the United Kingdom for living related transplants or to India, taking advantage of commercially available organs, usually with poor outcomes. There have also been attempts in the past to import allografts from Europe and the United States. After 1979 revolution, kidney transplantation was activated in Iran by using living donors which was know as Iranian model. Recently, there has been emphasis to expand deceased donor kidney transplantation. However, there are several challenges to expand transplant care in Iran.

The Relationship Between Blood Group and Colon Cancer in Shiraz Namazi Hospital During 2002 - 2011

Background: Cancer is the second cause of death in the world and the third in Iran. Colorectal cancer is the third fatal cancer in the world. Objectives: Blood group and its RH are among the genetic factors that can be associated with colon cancer. This study was performed with the aim of investigating the relationship between blood group and colon cancer. Methods: This study was undertaken in cases of colon cancer that referred to Namazi hospital from 2002 to 2011. The required data were gathered using a checklist, entered into SPSS software, and analyzed with descriptive statistical methods and Chi-square test. Results: The results showed that the highest frequencies among 223 patients with colon cancer were related to blood group O+ (48.7 percent), RH+ (90.4 percent), male patients (60.4 percent), and married people (72.2 percent). The mean age of the patients was 60.09 ± 16.04. Blood group and colon cancer showed a statistically significant relationship (P < 0.05). Conclusions: The findings showed that there is a statistically significant relationship between blood group and colon cancer. Conducting extensive studies to find risk factors of the disease, particularly the role of genetic factors and disease prevention, in susceptible people is recommended.