Showing papers in "Iranian Journal of Public Health in 2008"

Vitamin D Deficiency in Iran: A Multi-center Study among Different Urban Areas

Abstract: Background: Recent studies have reported different prevalence of vitamin D deficiency in different sex and age groups in developing countries. In the present survey, we elucidated the prevalence of vitamin D deficiency in a multi-center study among Iranian population. Methods: In a random cluster sample of healthy men and women (ranged 20 to 69 years old), a number of 5232 subjects from five urban metropolitans’ cities (Tehran, Tabriz, Mashhad, Shiraz and Booshehr) were recruited in 2001. Fasting blood sample was taken from participants and sent to the laboratory for measurement of 25-hydroxy vitamin D level. Meta-analysis was performed using fixed effect method for estimation of vitamin D deficiency prevalence in a national level. Results: Moderate to severe vitamin D deficiency was estimated in urban areas (except for Booshehr because of its heterogeneity) equal to 47.2, 45.7 and 44.2% in age groups of <50, 50-60 and 60≤ years, respectively among men and 54.2, 41.2 and 37.5 percent among women in the same age groups. The highest prevalence of moderate to severe vitamin D deficiency in men was observed in Tehran. Mashhad and Booshehr had also the lowest prevalence of moderate to severe vitamin D deficiency among men and women. Conclusion: Iran is a country with high prevalence of moderate to severe vitamin D deficiency and the prevalence of this deficiency is more evident in Tehran, capital of Iran. Therefore, consideration of main predictors for vitamin D deficiency in all age groups especially in Tehran is recommended.

Diagnosis and characterization of Leishmania species in Giemsa-stained slides by PCR-RFLP.

Abstract: Direct identification of Leishmania species in Giemsa-stained slides without parasite culturing in the areas where multiple species exist, is very helpful. This study was designed to isolate Leishmani spp. from Giemsa-stained smears and to characterize them by PCR technique. Methods: A total of 48 Giemsa-Stained slides from confirmed cases of leishmaniasis were examined under a light micro- scope at×1000 and classified based on grading of Leishmania parasites. DNA from each slide was extracted separately and subjected to PCR. The ribosomal internal transcribed spacer 1 (ITS1) was amplified with specific primers and the PCR products were digested with a restriction enzyme (HaeIII). Results: Of the 48 microscopy-positive slides, 43(89.6%) were positive by PCR-RFLP and Leishmania species were identi- fied. A statistically significant difference was observed between the both methods (P< 0.05) and also a concordance was found between microscopy and PCR-RFLP (k= 0.55). Conclusion: PCR-RFLP seems to be an effective method to identify Leishmania species from Giemsa-stained smears which have been collected from both infected humans and animal reservoir hosts in Iran.

Glucose-6-phosphate dehydrogenase (g6pd) deficiency

Abstract: Glucose-6-phosphate dehydrogenase (G6PD) Deficiency is the most prevalent enzymopathy in mankind. It has sex-linked inheritance. This enzyme exists in all cells. G6PD deficiency increases the sensitivity of red blood cells to oxidative dam- age. G6PD deficiency was discovered in 1950 when some people suffered hemolytic anemia as a result of taking antimalar- ial drugs (primaquin). Most people with G6PD deficiency do not have any symptoms, till they are exposed to certain medi- cations, Fava beans and infections; and then their red blood cells are hemolyzed. The degree of hemolysis changes accord- ing to the degree of enzyme deficiency and the oxidant agent exposure. G6PD deficiency has many different variants and Mediterranean variant is the most common mutation in the world. G6PD deficiency is considered a health problem world- wide, especially in Asia, Middle East and Mediterranean countries. In this article, we have reviewed the importance and function of G6PD enzyme, incidence rate of G6PD deficiency in the world and Iran, genetic and variants of this enzyme, clinical manifestation, diagnosis and treatment of the enzyme deficiency.

Molecular characterization of the Iranian isolates of Giardia lamblia: application of the glutamate dehydrogenase gene

Abstract: Background: This study was conducted to determine of molecular epidemiology of the Giardia lamblia by PCR-RFLP method in Tehran, capital of Iran. Methods: Thirty eight stool samples were randomly selected from 125 patients diagnosed with giardiasis using microscopy in Tehran. DNA extraction of some samples were performed by phenol/chloroform/isoamyl alcohol method and to raise the sensitivity of the PCR assay, the genomic DNA of the others were extracted using glass beads and the QIAamp Stool Mini Kit in order to effectively remove the PCR inhibitors. A single step PCR-RFLP assay, targeting the glutamate dehydrogenase (gdh) locus, was used to differentiate within and between assemblages A and B that have been found in humans. Results: Of the 38 isolates, 33 samples (87%) were found as G. lamblia (genotype AII), 3 (7.8%) belonged to assemblage B, genotype BIII, the mixed of genotype AII and B were detected only in two samples (5.2%). Conclusions: PCR-RFLP is a sensitive and powerful analytical tool that allows effective genotype discrimination within and between assemblages at targeting gdh gene, and makes it possible to identify the presence of mixed genotypes. Our data suggest that there is an anthroponotic origin of the infection route, assemblage A group II, in Tehran so it seems that the main reservoir of Giardia infection is humans in the area studies.

Lifetime pattern of substance abuse, parental support, religiosity, and locus of control in adolescent and young male users

Abstract: Background: In the current study, pattern of substance abuse among adolescence and early adulthood that have experienced one or more substances was assessed, and also parental support, religiosity, and locus of control were measured. Methods: This cross-sectional study was conducted in Hamadan City, Iran in 2006. All subjects were selected from Hamadan City (urban area), Iran based on snowball sampling method. Participants were males who used alcohol and illicit drugs in their life (n=398), completed a self-administered questionnaire. Results: Approximately half of the participants were used to smoke, drink, take marijuana and/or use opium regularly, and one in ten had taken ecstasy or heroine in the last weeks. Tobacco and alcohols were most common substance as a gateway and consequently marijuana and opium were the next substances. Initiation age result for using substance was ages 13 to 18 years. More than 90% classified as group who suffering familial support, 60.8% as low level of religiosity, and 51.5% of participants was external locus of control. Conclusion: Our findings were similar to western countries pattern except that for opium. The high rate substances use by adolescents and changes in pattern of use suggests that all drug use need to be taken into account when addressing adolescents' substance use. Moreover, research is needed to identify possible mechanisms underlying the association between binge drug uses in the vulnerable groups.

Detection of Brucella by Peripheral Blood PCR and Comparison with Culture and Serological Methods in Suspected Cases

Abstract: Background: Brucellosis is a zoonotic disease and its symptoms and appearances are not exclusive in human and its traditional diagnosis is based on blood culture and serological methods. For more sensitive and specific detection, the PCR method is recommended. Methods: One hundred four blood samples were gathered from suspicious patients with brucellosis different ages form Kermanshah, Mazandaran, Khorassan and Hormozgan provinces, and were examined by Rose Bengal, anti globulin, culture and PCR methods. Results: Seventy three samples were positive by PCR method, 15 samples were positive by cultured method and 84 samples were positive by serological methods. Conclusion: PCR method is sensitive and specific for diagnosis of Brucella from peripheral blood in suspected cases.

Proposing a National Ethical Framework for Animal Research in Iran

Abstract: Background: One of the domains of scientific activities is working on animals. Performing experiments on animals is permissible only with the purpose of obtaining necessary information for saving and improving life of human beings or animals. Principally, all religions believe that human life is more valuable than animal life and humans have a God-given authority over animals, but they should not be cruel to animals and cause their pain or suffering. Based on Islamic view points, although Allah has put the Man as the lord of all creatures, he has not the right to use other creatures for any conditions and does not respect their real statues. Because of the widespread use of experimental animals in our country, special ethical codes should be redefined for living conditions of experimental animals based on the present regulations in Iran and also other countries. Therefore, all our researchers should have enough information about ethical codes of treating experimental animals as well as Islamic principles in this regard. Methods: All Islamic and international sources related to treating animals and also valid international ethical guidelines were collected and classified in order to extract the aimed points. Then all extracted points were reviewed by experts familiar with Islamic and ethical rules of treating animals. Results: Finally the strategies for appropriate and complete implementation of the national ethical guidelines of animal research in Iran were suggested. Conclusion: It is obvious that the suggested principles are applicable only with appropriate planning of training courses based on the facilities and needs of our country.

Iranian Osteoporosis Research Network: Background, Mission and Its Role in Osteoporosis Management

Abstract: of increase in elderly population, osteoporosis appears to become as a major public health issue in developing countries as in Iran. In order to obtain a clearer picture of osteoporosis in Iran, studies on different aspect of osteoporosis especially national projects about epidemiology and burden of disease, are required. Coordinating research programs is pos- sible only by establishing a research network, so the national osteoporosis research network was suggested by Endocrinol- ogy and Metabolism Research of Tehran University of Medical Sciences. Iranian Osteoporosis Research Network (IORN) was established in 2002 by approval of Deputy for Research and the National Advisory Committee on Non-communicable Diseases of Ministry of Health and Medical Education of Iran. At first, five centers of Medical Sciences Universities and Research Centers in addition to the EMRC, participated in this project. Gradually more centers joined to the network and the numbers of IORN members are now 41 persons from 21 universities and research centers. IORN has had several activi- ties: 1) Research projects, from among them are Iranian Multi-center Osteoporosis Study (IMOS) and Hip Fracture Registry Project (HFRP) in Iran 2) Educational activities with the aim of preventing osteoporosis and its related fractures 3) Establishment of osteoporosis clinic. In summery osteoporosis is an important public health issue especially in developing countries be- cause of increasing in elderly population. Close relationship between academic and research centers through the IORN mem- bership provided possibility of designing and applying national research projects on epidemiology and burden of osteoporosis.

Economic Valuation of Air Pollution Health Impacts in the Tehran Area, Iran

Abstract: Air pollution in Tehran, capital of Iran is responsible for several diverse negative effects. It has been estab- lished that air pollution can affect human health. These health effects include increased hospital admissions due to the ex- acerbation of cardiac and respiratory diseases, as well as symptoms such as headache, cough, eye irritation, nausea, sputum and even death in the most vulnerable individuals. In evaluating any policy that would reduce air pollution, it is useful to compare the policy's costs to its benefits expressed in monetary units. Methods: Since there is no market available that places value on the benefits of improved air quality, we must undertake non market valuation methods. In this paper we used direct medical cost (DMC), contingent valuation (CV) and value of statistical life (VOSL) approaches and household production model of health. According to this study marginal health dam- age costs for the following type of pollutants impacts: sulfur dioxide (SO2), nitrogen dioxide (NO2), particulate matter (PM10) and carbon monoxide (CO) are quantified using exposure response functions(ERF) which relate pollutant con- centration to the resulting impact on a receptor(health). ERFs for health impacts are derived from epidemiological studies. Results: Health damage costs has been estimated at 16224 US$ per each unit increase of PM10, 28816 US$ per each unit increase of CO, 1927 US$ per each unit increase of NO2 and 7739 US$ per each unit increase of SO2. Conclusion: Substituting economic incentives for command and control approach to regulating air quality.

Hymenolepis diminuta (Rodolphi, 1819) Infection in a Child from Iran

Abstract: diminuta is a cestode frequently found in rodents and humans. Species of flour moths of the genus Pyralis and beetles in the genus Tribolium are common intermediate hosts. Humans can be accidentally infected through the ingestion of the insects, including larvae in precooked cereals, dried fruits or other food items, and directly by ingesting the insects from the environment. This tapeworm, while infrequently encountered, has been reported from many parts of the world. In this paper we report the first case of infection with H.diminuta in Iran since 1972.

Ethical Codes of Nursing and the Practical Necessity in Iran

Abstract: is a universal health care necessity. Nursing profession, similar to the other medical professions, is responsible to maintain public health promotion, prevent diseases, and also care and rehabilitate client, family and the society. The inher- ent nature of nursing is respect for moral values and human rights. However, clinical ethical dilemmas occur for nurses at all levels, not always concerning patients. Although this is the primary area of concern, it is relevant to all areas of nursing practice and every aspect of their professional roles including research activity, education and management. The ethical codes of nursing, which set out the ethical behaviors expected of registered nurses, are considered indisputable with regard to nursing practice. There are some national codes in the world but the international code of ethics for nurses was first adopted by the International Council of Nurses. The current paper gives an overview of nursing ethics history, which will be followed by the study on the promotion and dissemination of the nursing ethical codes and guidelines. The concepts, topics and strategies of some codes will be stated in this paper. The present study also aims to emphasize nursing ethics in Iran. Despite the compiling of general and specific guidelines of biomedical research in Iran during recent decade, there have been limited activities on the issue of nursing codes of ethics. Iranian nurses should be educated and fully prepared to en- gage with ethical issues in the field of nursing. Given the importance of sociocultural issues, it is necessary to compile nurs- ing codes of ethics according to Islamic culture of Iran

Secular Trend of Height Variations in Iranian Population Born between 1940 and 1984

Abstract: Background: Iran, a low- to middle-income country, has experienced considerable socioeconomic changes in 20 th century, which their impacts on the adult heights has not been assessed deeply by now. This article aims to quantify the temporal variations of height (with respect to shrinkage of height due to aging) and its deterministic factors in Iranian population born between 1940 and 1984. Methods: We analyzed the data of a large-scale national population- based survey that recruited 89,532 healthy subjects aged from 15 to 64 in 2005. Having used the Baltimore Longitudinal Study of Aging formulae, the shrinkage of height due to aging was adjusted. We modeled the estimated maximum height using multivariate regression analysis based on year of birth, sex, residing area and literacy. Moreover, we generated series of country maps showing the average of height classified by decades and provinces. Results: On average, the height of Iranian population has increased around 1.28 cm per decade (1.17cm in females; 1.53cm in males). The most prominent jumps of male and female heights are observed in 1970s. However, the jump of height in women has occurred around 3.5-10 years later than in men. Conclusion: We found a very sharp and clear increasing trend in height among those who were born between 1940 and 1984. Our findings support the fact that the socio-economical variations have had considerable impact on the maximum height of people; this can prove the population height measure as a good historical determinant for socio-economical development trend.

A Comparative Study on Sensitivity and Specificity of Conventional and Unconventional IgG and IgM Assays for Diagnosis of Toxoplasmosis

Abstract: Toxoplasmosis is a zoonotic disease with widespread distribution throughout the world It is caused by the protozoan parasite Toxoplasma gondii As laboratory diagnosis of toxoplasmosis is not straightforward, this study was aimed to compare the sensitivity and specificity of conventional and unconventional methods of diagnosis based on the measurement of IgM and IgG for determination of the best method Methods: One hundred suspected cases of toxoplasmosis referred to two laboratories in Tehran and Karaj were entered into this comparative analytical study The serum specimens of these cases were tested with ELISA, IFA, chemiluminescence (CLIA) and ELFA for presence of IgG and IgM Results: When compared with the ELFA IgG method, the CLIA IgG had the highest sensitivity, specificity, and positive and negative predictive values (100%) In comparison with ELFA IgM method, CLIA IgM and ELISA IgM had the same sensitivity (92%), but the sensitivity of ELISA IgM (100%) was higher than CLIA IgM (973%) The positive and negative predictive values of ELISA IgM were 100% and 974%, respectively and those of CLIA IgM were 96% and 98%, in that order Conclusion: Although, the reliability of the compared methods are close to each other, the automatic methods (CLIA, ELFA) are preferred because of high reproducibility, less personnel costs, shorter test time and etc Therefore, we recom- mend application of these methods for diagnosing of toxoplasmosis and re-emphasize that these are the most suitable tests for measurement of toxoplasma IgM levels

The Pattern of Injuries among the Victims of the Bam Earthquake

Abstract: Background: On December 26, 2003 an earthquake measuring 6.8 on the Richter scale, shook the city of Bam in the south east of Iran and killed more than 40000 people and nearly 30000 were injured. This is an epidemiological study performed on the victims of Bam earthquake to analyze different types of injuries of patients admitted in Kerman hospitals. Methods: In a retrospective cross-sectional study the medical records of 1250 victims of Bam earthquake admitted in Kerman hospitals from December 26, 2003 till 21 March, 2004 were reviewed and general demographic data such as age, sex, date of admission, type and anatomical site of injuries, diagnoses and complications were recorded. Results: More than half of the patients were male. The mean age was 29.28±11.89 years. Lower limb injuries (40.8%) and pelvic injuries (26.2%) were the most common. The least common injury was chest injury (10.9%). More than 50% of patients had fractures. There were associations between chest injuries, vertebral column injuries and abdominal injuries and between vertebral column, chest and skull fractures. The numbers of injury and fracture locations for each patient were 0.186±0.11 and 0.0886±0.098, respectively. Conclusions: The study of individual factors and associations between different locations of injuries indicates a careful physical examinations and attention to special groups. It is important to use findings of epidemiologic studies on disasters to establish well-organized crisis registration system for the next disasters.

Clinical Features of Cutaneous Leishmaniasis and Direct PCR- Based Identification of Parasite Species in A New Focus in Southeast of Iran

Abstract: Background: To clinically characterize the cutaneous leishmaniasis and identify the causative parasite species in Mirjaveh, an important geographical region across the border of Iran-Pakistan at Southeast of Iran. Methods: A number of 116 patients during a year since March 2005 to April 2006, subjected to the study. Clinical information collected and scrapings were taken from cutaneous lesions and used for microscopic examination, NNN cultivation and kinetoplast DNA-PCR amplification. Results: The cases comprised of 48 males and 68 females, 84 (72.4%) Iranians and 32 (27.6%) non-Iranians. They aged between 2 months to 68 years with the most affection of children, 0-10 years (55.2%). The patients presented a total of 248 active lesions with an average of 2.14. The ulcers distributed mostly on upper extremity (42.3%) then on face (32.7%), followed by lower extremity (20.6%) and other parts (4.4%). The majority of ulcers stated to be developed rapidly, <1 month (40.3%) or 1-2 months (45.2%). However, from 248 ulcers, only 19 (7.7%) found to be wet and the remaining were dry or moderately wet, 45 (18.1%) and 184 (74.2%), respectively. kDNA-PCR assay detected 51 out of 73 samples, all of which were identified as L. major, the causative agent of zoonotic cutaneous leishmaniasis. Conclusion: L. major is the species responsible for cutaneous leishmaniasis in Mirjaveh, however the pattern of clinical findings, does not completely resemble the ZCL characteristics. These indicate that the manifestation of the lesions may not necessarily correspond to the Leishmania species and may be unreliable to conclude the speciation of parasite without laboratory identification.

Hepatitis C Virus Infection and HCV Genotypes of Hemodialysis Patients

Abstract: Background: To evaluate the prevalence of hepatitis C by antibody testing, HCV-RNA detection by PCR and relative risk factors of HCV infection among HD patients and staff members in Markazi Province/Iran. The other purpose was to determine genotypes of HCV in this population. Methods: The study group consisted of 204 HD patients and 47 staff members from all 9 dialysis centers in Markazi Province, Iran. Anti-HCV antibodies were tested using a third generation ELISA and confirmed by RIBA. HCV RNA was determined by RT-PCR and genotyping was performed by a reverse hybridization assay (LiPA). Results: The overall prevalence of HCV (HCV antibody and HCV-RNA) was 5.4%. Female sex (P= 0.019), duration of dialysis (P= 0.003) and kidney transplant (P= 0.049) were significantly correlated with HCV infection. The predominant subtype was HCV-1a, detected in 4(50%) of the 8 HD patients. Genotype 4, 3a and 1b were found in 2(25%), 1(12.5%) and 1(12.5%) patients respectively. The prevalence of anti-HCV among staff members of HD units was 0%. Conclusion: The presence of anti HCV positive patients who had never been transfused, high prevalence of genotype 4 in this population, duration of HD as a risk factor for HCV positivity and non significant association between blood transfusion and HCV infection suggest nosocomial transmission of the virus in dialysis units that needs to be confirmed by phylogenetic analysis of subgenomic regions of HCV. HD staff members dose not seem to be at increased risk of hepatitis C despite the frequent blood exposure and lack of strict adherence to universal infection control precautions.

Detection of Leishmania major in naturally infected sand flies using semi nested-PCR.

Abstract: Background: The aim of this study was to assess Leishmania infection in sand fly species from areas where leishmaniasis is endemic. This is important for prediction of the risk and expansion of the disease. Methods: In this cross-sectional study we used a PCR-based method for detection of Leishmania minicircle DNA within individual sand flies from Orzoieh, a new endemic leishmaniasis focus in southern Iran. Results: We detected minicircle DNA in 6 of 92 (6.5%) Phlebotomus (Phlebotomus) papatasi collected indoor, while all of previous microscopic examination of sand flies specimens was negative for Leishmania promastigotes in the region. The species were identified as Leishmania (Leishmania) major by comparison of PCR products with a L. major positive control. All the Leishmania-positive sand flies were confirmed as P. (P.) papatasi by using a morphological key of Iranian sand flies. Conclusion: Since PCR method is relatively easy and can process a large number of samples, it will be a powerful tool for the rapid identification of Leishmania species as well as monitoring the infection rate in sand fly populations in areas of low endemicity of leishmaniasis.

Correlation of HER2/neu Over Expression, p53 Protein Accumulation and Steroid Receptor Status with Tumor Characteristics: An Iranian Study of Breast Cancer Patients

Abstract: Molecular biomarkers are valuable in evaluation the course of malignancies. In this study, the relationship between HER2/neu, p53, steroid receptors and clinicopathological features of patients with breast cancer has been assessed. Methods: Three hundred thirty nine women with a primary diagnosis of breast cancer from 2001 to 2006 were included. They were evaluated for tumor features. The content of the steroid hormone receptors and expression of HER2/neu and p53 was also examined by immunohistochemistry assay. Results: From patients arrived at this study, 52%, 36%, 46.5% and 44% were positive for HER2/neu, p53, ER and PR respectively. No association was found between most of pairs. HER2/neu expression significantly related with grade (P= 0.016). P53 had considerable reverse relation with axillary lymph node involvement and primary distant metastasis (P= 0.010 and P= 0.023, respectively). A significant association was found between PR and lymph node involvement (P= 0.038). Conclusion: This study present the pattern of prognostic biomarkers in breast cancer for the first time in northeast of Iran and suggests to conduct larger studies regarding other effective variables include demographic ones.

Prevalence of HPV Infection and Its Association with Cytological Abnormalities of Pap Smears in Tehran

Abstract: Human papillomavirus infection is one of the most common genital infections. More than 100 types of this virus have been identified, and most of them are capable of infecting the genital mucosa. Human papillomavirus is in association with cancerous and precancerous lesions of the cervix; some types like HPV 16 and 18 are highly carcinogenic, some types like HPV 31 and 33 are moderately and some types like HPV 6 and 11 are mildly carcinogenic. In this research, the relationship between cytological changes of the squamous epithelial cells and the presence of HPV infections in our cases has been assessed. Methods: In this prospective study, we collected 681 samples from women admitted to different hospitals and private gynecological clinics in Tehran, during the years 2003-2005. Two specimens were collected from each patient; one for a Pap smear study and the other for PCR assay in order to detect HPV. Results: Out of our 681 samples, 600 specimens were suitable for PCR assay, and 34 cases were HPV positive in PCR assay. This means that 5.7 percent of our patients were infected with HPV. Conclusion: HPV infection is common in Iran and is nearly identical to European countries such as Germany, and Spain. Also, we found that using PCR assay in order to detect the presence of HPV viruses in vaginal discharges can be very helpful.

The Spectrum of β -thalassemia Mutations in Isfahan Province of Iran

Abstract: Background: β-thalassemia is a common autosomal recessive disorder resulting from over 200 different mutations of beta globin genes. The aim of the present study was to identify the distribution and frequency of the most common β-thalassemia mutations among the population of Isfahan Province in central Iran. Methods: The data presented here were derived from a total of 114 β-thalassemia chromosomes of 18 affected patients and 78 unrelated carriers identified in our screening program. Furthermore, 23 pregnant women were analyzed among couples with a PND request for β-thalassemia. Allele identification was carried out using routine Reverse Dot Blot, ARMS, and genomic sequencing. Results: The most common mutation, IVS-II-I, followed by FSC-36-37, IVS-I-5, FSC-8-9, IVS-I-110, IVS-I,3’-end; -25bp, IVS-II-745, FSC-8, Cd-39, FSC-22-24, IVS-I-1, Cd-44, IVSII-2,3 (+11/-2), IVS-I-6, and FSC-16, respectively. The present study not only provides a guide for distribution and frequency of both recurrent and uncommon mutations, but also for the first time, reports a rare β-thalassemia mutation, IVSII-2, 3 (+11/-2), in the Isfahan province of Iran. Conclusion: The information presented here could greatly facilitate screening for β-thalassemia and prenatal diagnosis in the province of Isfahan.

Dietary intakes of adolescent girls in relation to weight status

Abstract: Background: To examine macronutrient and micronutrient intake of adolescent girls of Tehran, capital of Iran to discover any malnutrition in relation to weight status and dieting. Methods: A cross-sectional study was conducted. Four hundred 11- to 17-year-old students were selected by multistage cluster sampling from secondary and high schools of Tehran. The information about dietary intakes was taken by food frequency questionnaire and 24-hour recall form. The students’ body mass indices (BMIs) were measured and were classified according to National Center for Health Statistics /Center for Disease Control and Prevention (2000) growth charts. Participants were also questioned about body image and dieting. Results: 6.7% of adolescent girls were classified as being obese, 14.6% overweight, 75.4% normal and 3.2% underweight. Students 11-13 year old, had mean intakes lower than estimated average requirement (EAR) for folic acid, vitamin E, calcium, magnesium, phosphorus, potassium and sodium, and 14-18 year old students had mean intakes lower than EAR for niacin, pyridoxine, folic acid, pantothenic acid, vitamin E, calcium, magnesium, phosphorus, potassium, sodium and zinc. Obese and overweight adolescents had less carbohydrate, thiamin, niacin, iron and selenium intake. The participants, who were dieting, used significantly less amounts of proteins, carbohydrates, thiamin, niacin, iron, selenium, sodium and zinc. Conclusion: Knowing the harmful consequences of nutrient deficiency especially in adolescents, nutrition education must be emphasized in schools to promote nutritional literacy.

Molecular Characterization of Epidemic Isolates of Vibrio cholerae O1 by Arbitrarily primed PCR (AP-PCR)

Abstract: Epidemic and endemic cholera is a major public health problem for many countries. Aim of this study was to evaluate AP-PCR for investigation of clonal relatedness among the strains of Vibrio cholerae recovered from an outbreak occurred in different parts of Iran in 2005. Methods: The study was conducted during the cholera outbreak occurred in some of provinces in Iran in summer 2005. Bacterial isolation and identification was carried out according to the standard bacteriological methods. Arbitrarily primed PCR (AP-PCR) used to study the genetic relatedness between the V.cholerae isolates. Results: Thirty-nine isolates of V.cholerae O1 were identified. All isolates belonged to serotype Inaba. AP-PCR could dif- ferentiate the isolates into five groups. AP-PCR cluster types 1 and 2 were the most prevalent groups, accounting for 36% and 41%, respectively, of V.cholerae isolates. Conclusion: The most of epidemic strains of V.cholerae O1 isolated in the year 2005 could be attributed to two pre- dominant clusters including AP-PCR cluster types 1 and 2 accounting for more than 77% of isolates. In conclusion, a few epidemic clones were responsible for the apparently epidemic occurrence of cholera in provinces studied.

Prevalence of HAV among Healthy Blood Donors Referring to Tehran Transfusion Center

Abstract: Hepatitis A virus (HAV) is a single strand and non-enveloped RNA virus. It is usually transmitted by the fe- cal-oral and the blood transfusion routes and causes the hepatitis A disease. Clinically, the hepatitis A is usually mild, par- ticularly in children, in whom it is frequently subclinical. The disease is more serious and prolonged in adults. The objective of this study was to find the prevalence of HAV among blood donors in Tehran, Iran. Methods: Sera of 407 blood donors in Tehran Blood Transfusion Center who were negative for anti-HIV, HBs Ag and anti-HCV were tested for total anti-HAV antibody, anti-HAV IgM and HAV RNA. Total antibodies (IgG+IgM) and IgM were determined by ELISA using commercial kits. HAV RNA was detected by nested RT-PCR. Results: The prevalence of total anti-HAV antibodies in blood donors were was 86%, and also the ratio 99% of blood do- nors was negative for anti-HAV IgM and 1% was equivocal. HAV RNA was not found in any serum samples. The preva- lence of total anti-HAV antibodies among blood donors was high; it means most of them were infected in childhood. In spite of, 14% of blood donors were negative for total anti-HAV antibodies; the prevalence of anti-HAV IgM and HAV RNA were very low. Conclusion: Carefully blood donor selection is performed in Iran.

Anxiety, self efficacy expectation and social support in patients after coronary angioplasty and coronary bypass

Abstract: Coronary artery bypass grafting surgery (CABG) and precutaneous transluminal coronary intervention (PCI) are safe and effective in the treatment of coronary artery disease. The aim of this study was to determine and compare anxi- ety, self efficacy expectation and perceived social support between CABG patients and PCI patients referral to receiving cardiac rehabilitation programs. Methods: In this descriptive- analytical study 150 patients with CABG and PCI were selected. The Spilberger state trait anxiety inventory, general self efficacy scale and perceived social support scale three instruments for collecting data in the present study. Results: PCI patients as compared to CABG patients experience higher anxiety (P= 0.02) and lower perceived social sup- port (P= 0.02). Self efficacy score in the PCI patients was higher than CABG patients (P= 0.01). Conclusion: It is necessary to be more considerate to psychological problems in the PCI patients.

Reliability, Validity, and Feasibility of the Mayo Gastro-Esophageal Reflux Questionnaire (GERQ) in a Persian-Speaking Population"

Abstract: Background: Gastroesophageal reflux disease (GERD) is prevalent in the West. Mayo-GERQ is one of the most widely used questionnaires for screening GERD. We validated GERQ in an Iranian population. Methods: The Mayo-GERQ was translated into Persian (P-GERQ) and reviewed and commented by two gastroenterologists. Eleven lay-people filled it in and commented on it. Reliability was assessed by test-retest within 2-6 wks in 53 hospital staff. Concurrent-validity was checked in another 53, comparing the results of the self-administered questionnaire with the questionnaires filled in by a gastroenterologist interviewing them. Weighted-kappa (κw) statistics was used. Time needed to complete the questionnaire, practicability of the directions and linguistic eloquence were checked (feasibility indices). Results were used to modify P-GERQ. The modified P-GERQ was tested in another 99 hospital employees in the same manner. Results: Phase-one; One-hundred seventeen subjects were enrolled (46 men). Mean time for completion was 23.7 minutes. Mean kw for reliability was 0.47 and that for validity 0.26. Sources of poor performance were sought, P-GERQ was revised and underwent validation again (2 nd phase). Phase-two: Ninety-nine individuals were enrolled (37 men). The modified PGERQ took 15.8+/-11.9 min to complete. κ-values for concurrent-validity of major symptoms (acid-regurgitation, heartburn) were 0.70 and 0.67 respectively. Corresponding κ-values for reliability were 0.57 and 0.80. Conclusions: P-GERQ was not valid initially. After making appropriate technical and linguistic changes, it achieved acceptable validity, reliability and feasibility. In addition to making available a useful tool for population-based studies, our results underscore the importance of validation before adopting a translated questionnaire.

Time of Occurrence and Age Distribution of Digestive Tract Cancers in Northern Iran

Abstract: Abatract Previous studies indicate a high incidence of digestive cancers along southern parts of Caspian Sea including Mazandaran Province. The present study was conducted to further investigate time to occurrence, age distribution and possible risks associated with the incidence time of digestive cancers in the above regions. Methods: For this purpose the data of digestive cancer incidence of 3723 cases during a five-year period of 2001 to 2005 collected from Babol Cancer Registry Center in Iran. Almost all cancer cases residence of Mazandaran Province is included in this study and so the results could be considered a population-based conclusion. In order to modify the mortality due to other causes before digestive cancers, and to adjust the effect of digestive cancers correlations, a competing risks model was used. The Cox regression model was used for study of risk factors on cancer incidence. Results: Although incidence of colorectal cancer was relatively low, however, unfortunately the age of onset was at the age category of 15-19, much sooner than occurrence of stomach cancer which was at 20-24 yr (P< 0.0001), and esophageal cancer at age category of 30-34 yr (P< 0.0001). Conclusion: Life tables of all digestive cancer, esophageal cancer, stomach and colorectal cancers were presented in this paper. Risks related to these cancers are significantly higher in men and residences of urban areas than their baseline counterparts. (P< 0.0001) More studies needed to identify risk factors and high risk cases for screening and prevention programs.

First Database Report on Cardiothoracic Surgery in Tehran Heart Center

Abstract: Background: The use of cardiac surgical database is necessary for evaluating and improving the quality of care. The aim of this report was to provide useful information for surgeons in Iran and other countries for their daily practice. Methods: We analyzed data from 14288 consecutive patients in four different types of procedures, namely isolated coronary artery bypass grafting (CABG), combined CABG and valve (CABG-V), only valve (V), and other adult cardiac surgical operations from 2002 to 2006. Results: The activity load increased from 1765 in 2002 to 3309 surgical operations in 2006 with almost 87.2% of activity being isolated CABG. The mortality rate for CABG was 1%, which decreased from 1.7% to 0.9% over the five years. The mortality rates for CABG-V and V were 5.8% and 4.8% in the last year of the study, respectively. Over the 5 yr period, the proportion of urgent operations increased substantially from 4% to 24.5% (P< 0.0001), causing a reduction in elective operations. The mean length of hospital stay for the entire population was 8.38±5.74 d, which remained almost steady during the study period. Conclusion: This database can serve as a valuable resource of preoperative measurers and surgical outcomes for surgeons and researchers with a view to improving overall surgical performance.

Acinetobacter baumannii infection in the neonatal intensive care unit.

Abstract: Background: To perform a prospective case control study of blood stream infection to determine the infection rate of Acinetobacter baumannii and the risk factors associated with mortality. Methods: From February 2004 to January 2005, 579 consecutive episodes of blood stream infection were obtained at two neonatal intensive care units Al Nasser and Al Shifa hospitals in Gaza City. Forty (6.9%) isolates of A. baumannii were obtained from the neonates under 28 d. Most of the isolates (92%) were from hospitalized patients in the intensive care units. Results: Community acquired infection was 8%. Sixty three percent of the patients were males. The isolates of A. baumannii were resistant to commonly used antibiotics while being sensitive to meropenem (92.5%), imipenem (90%), chloramphenicol (80%), ciprofloxacin (75%), gentamicin (57.5%), ceftriaxone (50%), amikacin (37.5%), cefuroxime and cefotaxime (35%). Over all crude mortality rate was 20% with much higher crude mortality among patients with nosocomial infection. Based on logistic regression, the following factors were statistically significant: weight < 1500g, age < 7 d, mean of hospitalization equal 20 days, antibiotic use, and mechanical ventilation, when compared to the control group (P< 0.05). Conclusion: Infection rate of nosocomial blood stream infection was considerable and alarming in neonatal intensive care unit infants and associated with a significant excess length of NICU stay and a significant economic burden.

Prevalence of Tongue Anomalies in Hamadan, Iran

Abstract: Since the earliest days of medicine, the tongue has been considered a good reflection of systemic disease. Hippocrates, Galen and others considered the tongue to be barometer of health. In addition, the early diagnose of tongue le- sions help to recognize the some systemic diseases. The purpose of this study was to determine the frequency of different morphological variations (anomaly) of the tongue in a population of school children aged 6-12 years in Hamadan, Iran. Method: This cross sectional study was held with questionnaires and face-to-face interview among 1600 schoolchildren 6- 12 years old (800 girls, 800 boys) with cluster randomize method were selected and examined. Each school was considered as a cluster that was selected by randomized selections in view of the total sample size. Results: Tongue lesions were found in 39.7% of the children. Overall, the most frequent condition was geographic tongue (27%) and fissured tongue (12.9%). Microglosia and median rhomboid glossitis were in 0.2% of cases. Conclusion: The present study indicates a higher frequency of tongue abnormalities specially geographic tongue than previ- ous studies however further investigation are required to indicate if hereditary and congenital factors play a vital role or if the environmental factors in this region vary with those in their regions. On the other hand the findings from this survey should serve as a baseline for future studies.

Epidemiology and Antimicrobial Resistance of Enteric Pathogens in Dhahira Region, Oman

Abstract: Background: We reviewed the monthly laboratory surveillance reports and hospital laboratory database in Dhahira region, Oman. Methods: All patients for whom a stool sample examination request was made from 1 st January 2002 to 31 st December 2006 (5 years) were included in the study. Antimicrobial resistance pattern was studied for 2 years period. The cultures were done using standard laboratory procedures and antibiotic sensitivity by Kirby Bauer disc diffusion method. Results: Of the 85,210 stool samples examined, 18% showed positive result for one or more parasitic infection. The most common were E. hystolytica (7.1%), Giardia (7.9%) and E. coli (1.9%). A total of 7,830 cultures were done, among them 11.4% showed positive result for bacterial pathogen. The most common were Salmonella (5.8%) and Shigella species (4.4%). The antimicrobial susceptibility patterns of 265 bacterial pathogens were analyzed. Of the Shigella strains, 71.8% were resistant to trimethoprim/sulphamethoxazole (SXT) and 39.4% to ampicillin and 32.4% to tetracycline. Salmonella and E. coli strains were frequently resistant to ampicillin (12.5% and 47.7%, respectively) Conclusion: This study provides important information on the prevalence and antimicrobial resistance pattern of enteric pathogens in Dhahira region population. SXT, ampicillin, and tetracycline are the drugs commonly associated with resistance.