Diagnosis-related group (DRG) system is patient classification system designed to produce limited number of classes which are relatively similar in terms of resource consumption and clinical characteristics. The aim of this study was to assess the level of knowledge, attitude and practice (KAP) of Turkish health care providers toward DRG system implemented in Turkey.A total of 238 healthcare providers were randomly selected from two urbanand one rural hospital in Turkey.A questionnaire was used for data collection; contacting 32 items (10 items about knowledge, 12 items about attitude and 10 items about the practice) and its validity and reliability were confirmed. Data analysis was performed using chi-square and multivariate logistic regression.In this study,only one third of healthcare providers showed good knowledge (35.7%) and good practice (37.4%) about DRG system,compared to 54.2% of them showed good attitude.There was significant difference between age, gender, occupation groups and whether the respondents have attended a workshop for DRG system in terms of KAP (p > 0.05).These results indicated the need for further actions to implement DRG system in terms of creation of suitable environment and increasing awareness among healthcare providers, especially male, medical doctors, nurses, elderly, and those who have never attended a workshop, in addition to regular review to ensure the program would reach its targets.

Background: This study investigated the possible protective effects of bilberry extract after exposing rat eyes to ultraviolet-B (UV-B) radiation. Methods: Four groups of rats were included in this study, each consisting of 10 Wistar rats. The first group acted as the control, and the second group was exposed to UV-B, 5 KJ/m2 (λm = 300 nm), for 15 minutes. The third group was orally administered bilberry extract (160 mg twice per day) for two weeks before exposure to the UV-B, while the fourth group was administered the same dose of bilberry extract for two weeks before euthanisation. A comet assay was used to examine DNA damage, while the malondialdehyde (MDA) level and superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT), activities were measured in the lens. Results: After exposing the rats to UV-B radiation, the mean percentage tail DNA and tail moment were significantly increased (P < 0.001) when compared to the control group. In the same context, the lens tissue MDA levels and CAT activity were also significantly increased (P < 0.001). The supplementation of the bilberry extract was found to improve the comet assay parameters and enzymatic activity of the rat lens tissue. Conclusion: The administration of bilberry led to a decrease in the oxidative stress in the lens tissues and DNA damage induced by UV-B radiation in the lenses of Wistar rats.
Vaccinium myrtillus ; DNA ; Comet Assay ; Malondialdehyde

AIM: To determine the clinical course and management of patients undergoing surgery for consecutive strabismus.METHODS: Patients less than 45 years of age presenting with consecutive strabismus were divided into two groups (1-Esodeviation and 2-Exodeviation). Angle of deviation was measured in prism diopter (PD). Conservative therapy was experienced during the course of follow-up after first surgery. All the subjects with deviation of more than 15PD after six months of follow-up were selected for repeat surgery. Compulsory investigations were performed. Secondary surgical procedures were performed under general anesthesia. Postoperative follow-up was done at 3 days, 15 days, 3 months and 6 months.RESULTS: Subjects(28.8%)developed consecutive stra-bismus within the study period. Second surgery on a dominant (fixating) eye in all patients was performed within 6 to 9 months after first surgery. After second surgical interven-tion, good surgical outcome was obtained and the tendency towards over correction was not observed in both groups during follow-up period.CONCLUSION: There is a need for guarded muscle correction during second surgery to avoid over corrections in future.

Cervical cancer is the seventh most common cancer among women in Iraq. This study aimed to assess the factors influencing Pap smear practice among married primary school teachers in Diyala City, Iraq. A total of 222 teachers (aged 20 years to 63 years) residing in Diyala City were enrolled in a cross sectional study from 1st August till 30th September 2012. The sampling method was a self-administered survey using a multistage sampling technique. The prevalence of Pap smear practice was very low (12.6%). Relatives and friends were the main source of information about the Pap smear test for more than one third (41.9%) of the respondents. However, the medical doctor’s advice was the most important reason for undergoing a Pap smear test in more than two third (60.7%) of respondents. Only 32.4% of the teachers have good knowledge about cervical cancer and Pap smear test, but 76.1% of them showed a positive attitude toward learning about cervical cancer and Pap smear. Based on multiple logistic regression analysis results only the husband’s encouragement (p= 0.003, prevalence odds ratio [POR] = 0.256, 95%CI 0.10-0.63) was significantly associated with Pap smear practice. A more effective educational program is needed to educate Iraqi women about cervical cancer and screening tests, including Pap smear.
Papanicolaou Test

This study was conducted to evaluate the discomfort level of students from the Polytechnic Kuching Sarawak while they were sitting on chairs. Polytechnic Kuching students (n=500) completed a set of questionnaires utilizing a survey form which showed the body chart discomfort using Borg’s CR-10 Scale. The students was asked to identify body areas experiencing discomfort and to rate this discomfort using score rating groups (0 to 5) where score 0-1.99 = No discomfort (1), score 2.00-3.99 = Discomfort (2) and score 4.00-5.00 = Very uncomfortable (3). The evaluation of seating discomfort levels showed acceptable levels for the students and possible outstanding problems. Students were asked to rank over an order 10 statements about comfort and choose three responses which gave the most consistent equal interval scale. The results showed that the main response of discomfort indicated the students felt cramped, stiff, numb, sore and tender muscle, unbearable pain, barely comfortable and uncomfortable. This project was identified to evaluate the comfort level for classrooms chairs of polytechnic students. Overall, there was a significant discomfort level for the students whilst sitting on chairs and a possible solution put forward is to design a new type of classroom chair made of natural fibre reinforced composite.

Objective: To assess the ameliorative properties of Iranian Trigonella foenum-graecum L. (T. foenum-graecum) seeds and Punica granatum L. (P. granatum) peel extracts against streptozotocin-induced diabetes in male guinea pigs. Methods: Sixty guinea pigs were divided into six groups (10 guinea pigs per group). Group 1 consisted of normal animals. Groups 2 and 3 were treated with Iranian T. foenum-graecum seeds and P. granatum peel extract alone, respectively. Group 4 was treated with streptozotocin only; whereas Groups 5 and 6 receiving streptozotocin were treated with Iranian T. foenum-graecum seeds and P. granatum peel extract, respectively. All animals were treated for 30 days, and the body weight, blood and liver biochemical parameters were measured. Results: Guinea pigs exposed to streptozotocin showed an alteration in body weight gain, fasting glucose level, kidney function parameters (blood urea nitrogen and creati-nine) as well as decreased serum and hepatic total protein level. In addition, it increased the cholesterol and triglyceride level, while decreasing the hepatic glucose-6 phosphate dehydrogenase activity, glycogen, glutathione content and hepatic catalase activity. Oral treatment with T. foenum-graecum seeds and P. granatum peel extracts revealed sig-nificant protective properties with respect to body weight gain and other biochemical parameters studied. Conclusions: The Iranian T. foenum-graecum seeds and P. granatum peel extracts are significantly potent in ameliorating diabetic condition induced by streptozotocin and improving various biochemical parameters in serum and liver of guinea pigs.

The routine identification of mycobacterial strains isolated from patients in different locations in Egypt was confirmed by specific DNA fragment amplification. The susceptibilities of 72 Mycobacterium tuberculosis strains against the four antibiotics used in tuberculosis treatment (Isoniazid, INH; Rifampicin, Rif; Streptomycin, St and Ethambutol, E) were examined. Our results indicated that, multi drug resistant tuberculosis (MDR-TB) represents about 19.5% of the tested strains, whereas sensitive strains represented 26.4%. The genetic polymorphism of the tested strains was examined using RAPD analysis. Six selected strains represent the different antibiotic susceptibility groups were examined using RAPD fingerprinting. No difference between the strains was recorded using the RFLP analysis of amplified specific fragment. The discrimination power of RAPD analysis was inadequate to clarify the genetic correlation between the tested strains. MDR-TB was approximately double time in 2008 compared with the value in 2007. Most of the new MDR-TB was correlated with resident dense population regions.

The vacuolating cytotoxin VacA and cytotoxin associated gene product CagA, encoded by vacA and cagA are major virulence determinants associated with pathogenesis of Helicobacter pylori. The presence and prevalence of two major H. pylori virulence associated genes among gastric biopsies of Pakistani children were investigated in the current study. Fifty one gastric biopsy specimens of children were analysed for 16S rRNA, vacA and cagA genes using PCR. The results showed that 21 (41.2%) biopsies were positive for H. pylori as determined by 16S rRNA PCR. In the 21 H. pylori positive gastric biopsies, 19 (90.5%) showed vacA s1a, 1 (4.75%) was vacA s1b and 1 (4.75%) was vacA s2 whereas, 5 (23.8%) were vacA m1 and 16 (76.2%) were vacA m2. None of the H. pylori positive biopsies carried vacA s1c subtype. The cagA gene was found in 13 (61.9%) of H. pylori infected biopsies and different vacA combinations were found with or without cagA gene. H. pylori was detected with high frequency of cagA while vacA s1a and vacA m2 regions with vacA s1a/m2 genotype were predominant in H. pylori infected gastric biopsies of children.

Aims: This study focused on new fish feed additives that could supply a nutritional value and inhibit or eliminate mycotoxins. Four novel feed additives, including Albizia lebbeck (L.), Leucaena leucocephala leaf extracts, Serendipita indica and Bacillus megaterium were applied to contaminated fish feed; besides investigating the toxicity of these new fish feed additives. Methodology and results : Our data exhibited that the different tested feed additives were not toxic for brine shrimp larvae or fish. Albizia lebbeck extract at a concentration 0.5% was highly effective in detoxifying mycotoxins with efficacy ratios of 88.01%, 93.89% and 92.89% for aflaB1, aflaG1 and CPA, respectively and L. leucocephala at 0.5% had efficacy ratios of 93.52% and 100% for aflaG1 and CPA, respectively. The addition of S. indica with a concentration of 0.75% was highly effective for the usage of good feed approximately free of mycotoxins, with efficacy ratios of 85.65%, 90.81% and 100% for aflaB1, aflaG1 and CPA, respectively. Moreover, B. megaterium, with a concentration of 0.75% was recommended for detoxification. Conclusion, significance and impact of study Studied new feed additives as feed additives in fish diets to eliminate mycotoxin with the potential of providing antioxidant activity. Results suggest that mycotoxins degradation can happen in vitro and in vivo by applying new fish feed additives in the fish diet.

Cardiac failure is a clinical syndrome that may develop in children owing to cardiac dysfunction or underlying structural heart diseases. Considering the differences in diagnostic and therapeutic approaches for pediatric heart failure (PHF) and adult heart failure, we have reviewed the current literature on PHF. Relevant studies were extracted from MEDLINE/PubMed, Google Scholar, and Clinical Trial Registries using the terms “pediatric heart failure” or “heart failure in children” and “management” or “decongestive therapy.” Recent advances in diagnostic approaches, such as cardiac magnetic resonance, speckle-tracking echocardiography, tissue Doppler imaging, and molecular diagnostic techniques, have increased our under -standing of PHF. It is imperative that clinicians evaluate the interrelated factors responsible for the develop ment of PHF, including myocardial function, pulmonary and systemic blood flow, heart rhythm, valve function, and nutritional status. Although recent advances have demon strated the efficacy of many new drugs in adult heart failure trials, it cannot be concluded that these drugs will show similar efficacy in children, considering the heterogeneous nature of the underlying mechanisms and variable pharmacody-namics and pharmacokinetics. Therefore, the underlying pathophysiology of PHF and the mechanisms of action of different drugs should be considered when selecting appropriate therapies. Further trials are needed to establi sh the efficacy and safety of these drugs, and a combined mul-ti disciplinary strategy will help enhance PHF outcomes.