Medical Journal of The Islamic Republic of Iran (MJIRI)

---

 Abstract

 Background: Clinical Risk Index of Babies (CRIB), Score for Neonatal Acute Physiology

 (SNAP), an update of the Clinical Risk Index for Babies score (CRIB II) and

 Score for Neonatal Acute Physiology - Perinatal Extension (SNAP-PE) are scoring devices

 developed in neonatal intensive care units. This study reviewed these scoring systems

 in critically ill neonates to determine how well they could predict mortality.

 Methods: This prospective cohort study was conducted at the neonatal intensive care

 units of Mofid and Mahdieh hospitals between March 2006 and May 2009. We evaluated

 CRIB, CRIB II, SNAP, SNAPII and SNAP-PE score for each neonate and the final

 scores were then obtained. The predictive accuracy of these parameters were expressed

 as area under the receiver operative characteristic curve, sensitivity, specificity, positive

 predictive value and negative predictive value.

 Results: Of 404 neonate evaluated 53% were male. Primary diagnoses were respiratory

 distress syndrome, gastrointestinal obstruction, sepsis, prematurity, and neuromuscular

 diseases. The authors detected mortality in 20.5% and found a significant difference

 in scoring systems between survived and death groups. The mean CRIB score in

 survived neonates was 2.57±3.66 and in death neonates 8.43±4.66 (p value<0.001). We

 also found that the SNAP score had the highest area under the curve and the highest sensitivity,

 specificity, positive predictive value, negative predictive value and we had the

 lowest score for CRIB II.

 Conclusion: We concluded that the neonatal scoring systems could be a useful tool

 for prediction of mortality in NICUs and SNAP can predict the mortality better than the

 others.

---

  Background :Disruption of anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. The choice of graft for (ACL) reconstruction remains controversial. This prospective, randomized clinical trial aimed to compare clinical results of bone-patellar tendon-bone (BPTB) grafts and four-strand semitendinosus-gracilis (ST) grafts for ACL reconstruction over a 3-year follow-up interval.

  Methods :Seventy-one patients with an average age of 29± 4.5yearswere treated for torn ACL between 2008 and 2009. Forty-sixpatients underwent reconstruction with BPTBautograft, and 41 were treated with STautograft.At the time of final follow-up, 37 patients in patella group and 34 patients in hamstring group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion,IKDC (International Knee Documentation Committee) score and complications.

  Results : At 36thmonth of follow-up, 34 (92%) and 28 (82%) patients in BPTB and ST group, respectively had good-to-excellent IKDC score (p > 0.05). Theactivity levelswerehigher in BPTB group(p> 0.05). At 3rd yearof follow up, the Lachman test was graded normal, for 23 (62%) and 11 (32%) patientsin BPTB and ST group, respectively(p=0.019).Regarding the pivot-shift test, 29 (79%) and 15 (44%) patients in patella and hamstring group, respectively had normal test at the latest follow-up (p=0.021).There were no significant differences in terms of thigh circumference difference, effusion, knee range of motion, pain and complications.

  Conclusion : Theresults indicate a trend toward increased graft laxityand pivot-shift grades in patients undergoing reconstruction with hamstring autograft compared with patella tendon. However, the two groups had comparable results in terms of activity level and knee function.

 

---

Background: The National Health Accounts keep track of all healthcare related activities from the beginning (i.e. resource provision), to the end (i.e. service provision). This study was conducted to address following questions: How is the Iranian health system funded? Who distribute the funds? For what services are the funds spent on?, What service providers receive the funds? Methods: The required study data were collected through a number of methods. The family health expenditure data was obtained through a cross sectional multistage (seasonal) survey while library and field study was used to collect the registered data. The collected data fell into the following three categories: the household health expenditure (the sample size: 10200 urban households and 6800 rural households-four rounds of questioning), financial agents data, the medical universities financial performance data. Results: The total health expenditure of the Iranian households was 201,496,172 million Rials in 2008, which showed a 34.4% increase when compared to 2007. The share of the total health expenditure was 6.2% of the GDP. The share of the public sector showed a decreasing trend between 2003-2008 while the share of the private sector, of which 95.77% was paid by households, had an increasing trend within the same period. The percent of out of pocket expenditure was 53.79% of the total health expenditure. The total health expenditure per capita was US$ 284.00 based on the official US$ exchange rate and US$ 683.1 based on the international US$ exchange rate.( exchange rate: 1$=9988 Rial). Conclusion: The share of the public and private sectors in financing the health system was imbalanced and did not meet the international standards. The public share of the total health expenditures has increased in the recent years despite the 4th and 5th Development Plans. The inclusion of household health insurance fees and other service related expenses increases the public contribution to 73% of the total.