Which Groups of Children Are at More Risk of Fatality during COVID-19 Pandemic? A Case-Control Study in Yazd, Iran

Introduction

The study aims to investigate the characteristics, comorbidities, laboratory findings, and clinical manifestations of under 18-year-old patients who died with the diagnosis of COVID-19 and determination of the most prevalent risk factors.

Method

This case-control study was performed at a referral hospital in Yazd from March 2020 to August 2021. All patients under 18 years who were diagnosed through real-time RT-PCR, chest computed tomography, and the World Health Organization definition were divided into deceased and survived groups. The characteristics (age and sex), disease severity, comorbidities, laboratory findings, and clinical manifestations of the two groups were compared and analyzed using SPSS, version 18 (SPSS Inc., Chicago, III., USA).

Results

A total of 24 patients in the deceased group and 167 patients in the survived group were compared. The highest mortality rate was observed in the age group of 1 month to 5 years, although no statistically significant relationship was found between age groups and the risk of mortality. Disease severity, dyspnea, low oxygen saturation on admission, length of hospital stays, and hospitalization history before the last admission were significantly correlated with mortality (P < 0.05). Lymphopenia increased the probability of mortality by more than two times (OR: 2.568; 95% CI (0.962-6.852)), but this was not the case for D-dimer and C-reactive protein. Furthermore, 27.5% of survived patients had normal chest CT scans, which was a statistically significant difference compared to the deceased patients (P: 0.031).

Conclusion

Based on the findings of this study, dyspnea, low oxygen saturation, and lymphopenia are critical indicators for identifying high-risk children with COVID-19 and triaging them for better care and treatment.

Survival and Mortality in Hospitalized Children with COVID-19: A Referral Center Experience in Yazd, Iran

Introduction

COVID-19 prognostic risk factors, therapeutic protocols, and clinical outcomes in pediatric cases are still under investigation.

Materials and Methods

This historical cohort study evaluated the survival time of hospitalized children (1 month-18 years old) with COVID-19 admitted from March 2020 to August 2021 to an educational hospital in Yazd, Iran. The follow-up of patients was performed at least one month after discharge.

Results

From 183 hospitalized cases, 24 children were deceased. The median age of patients was 5.41, and 54.2% were male. The survival rate after one-month follow-up was 0.88, and the most significant predictors associated with survival time were the male sex, positive history of hospitalization, lymphopenia, hypoxia, and length of stay more than two weeks using Bayesian Cox regression analysis.

Conclusion

Accurate estimation of the impact of predictors on poor outcomes may help healthcare providers use therapeutic protocols based on risk factors and healthcare requirements of each patient to improve their survival.

Evaluation of Rap1GAP and EPAC1 Gene Expression in Endometriosis Disease

Background

Endometriosis is a female reproductive system disease in which the endometrial tissue is found in other women's organs. Various factors are effective in the development of endometriosis, and because of the interaction of genetics and environmental factors, this disease is a multi-factorial disease. MAPK/ERK and PI3K/Akt/mTOR pathways are activated by growth factors and steroid hormones and are known as two important pathways involved in the processes of growth, proliferation, and survival of endometriosis cells. Raps, monomeric GTPase of the Ras family, are able to activate these pathways independent of Ras. The goal of our study was to evaluate the expression level of Rap1GAP and EPAC1 genes as two important RapGAPs (GTPase-activating proteins) and RapGEFs (guanine nucleotide exchange factors), respectively, in endometriosis tissues and normal endometrium tissues.

Materials and Methods

In this study, 15 samples of women without signs of endometriosis were taken as control samples. Fifteen ectopic and 15 eutopic samples were taken from women with endometriosis using laparoscopic surgery. The expression of EPAC1 and Rap1GAP genes was investigated by the real-time polymerase chain reaction technique, and the results were analyzed by one-way ANOVA test.

Results

EPAC1 upregulated significantly in ectopic tissues compared to eutopic and control tissues. Rap1GAP expression was lower in ectopic tissues compared to control and eutopic tissues.

Conclusions

Based on these results, it may be concluded that changes in the expression of the Rap1GAP and Epca1 genes may play a role in the pathways involved in the pathogenesis, displacement, and migration of endometriosis cells.

Insulin-like growth factor-1 on cycle day 2 and assisted reproductive techniques outcome: A cross-sectional study

Background: Individualized assisted reproductive techniques (ART) can improve ART outcomes. Some studies suggested using insulin-like growth factor-1 (IGF-1) level on cycle day 2 for individualized ART. Objectives: To investigate the relationship between the serum levels of IGF-1 on day 2 of the cycle and ART outcomes. Materials and Methods: In this cross-sectional study, cycle day 2 serum levels of IGF- 1 were measured in 175 women aged between 18-44 yr as candidates for in vitro fertilization or intracytoplasmic sperm injection. All participants received antagonist protocol, and the relationship between serum levels of IGF-1 and ART outcomes according to the number of oocytes were investigated; poor responders (oocytes < 5), normal responders (oocytes 5-15), and hyper responders (oocytes > 15). Results: Poor responders had higher serum level of IGF-1 when compared with normal and hyper-responders; however, this difference was not statistically significant (p = 0.41). The serum levels of IGF-1 in women with zero retrieved oocytes and those cycles that were canceled for the inappropriate ovarian response were not significantly different compared to other women in the group of poor responders. An inverse relationship was observed between the serum level of IGF-1 and anti-Mullerian hormone levels. Furthermore, no significant relationship between serum level of IGF-1 with age, body mass index, number of 2 pronucleus, and number of embryos was observed. Conclusions: According to our results, the serum levels of IGF-1 may not be able to predict ART outcomes. It seems necessary to conduct more studies with larger sample size in this field. Key words: Insulin-like growth factor-1, Poor ovarian response, Oocyte retrieval, Assisted reproductive technique outcome.

Investigating the effect of sodium chloride on the prevention of mucormycosis fungal infection in children with acute lymphocytic leukemia during treatment

Background: Given that no comprehensive study was conducted regarding the effect of sodium chloride on the prevention of mucormycosis fungal infection in acute leukemia patients during treatment, this study aimed the investigating the effect of sodium chloride  on the prevention of mucormycosis fungal infection in acute lymphocytic leukemia patients during treatment. Materials and Methods: This retrospective study was conducted on children with ALL who were undergoing chemotherapy in the induction phase and were susceptible to fungal and infectious diseases. Then 84 patients were randomly divided into the two groups. One group (n=46) received nasal drop containing sodium chloride (NORMONIX, 0.65%, three times a day) as the intervention group during treatment and another group did not receive sodium chloride (control group)(n=38). If the symptoms of mucormycosis was observed and detected (positive test), the injection of amphotrypsin B was started. Results: In the current study, 84 patients entered the study.  The mean age of patients in the control group and the intervention group was 7.84±3.45, and 6.45±3.4 years, respectively (P>0.05). Positive mucormycosis was seen in 24 (63.2%) patients in the control group and 16 (34.78%) patients in the intervention group (P=0.01). Conclusion: According to the findings of this study, the frequency of patients with positive mucormycosis in the NaCl group was significantly lower than the control group.  Therefore, it seems that NaCl drop can be effective regarding reducing the incidence of mucormycosis fungal infection and can decrease the need to amphotrypsin B, but further studies should be conducted in this regard.

The effect of erythropoietin on blood parameters in thalassemia intermedia patients

Background: β-thalassemia is the most common hereditary disease in Iran, and more than 2 million carriers of β-thalassemia live in Iran. On the other hand, our country is located in the thalassemia belt, and no comprehensive study has been conducted regarding the effect of erythropoietin on blood parameters in thalassemia intermedia patients in our region. Therefore this study aimed to investigate the effect of erythropoietin on blood parameters of thalassemia intermedia patients. Materials and Methods: This prospective cross-sectional study was conducted on all patients suspected of thalassemia intermedia in Shahid Sadoughi hospital from March 2021 to M 2022.  In the case of diagnosis of microcytic anemia, an electrophoresis test was performed, and people diagnosed with thalassemia intermedia entered the study. Then patients were divided into two groups (the intervention and control groups). The erythropoietin dose was 50-100 units/ kilogram (body weight) three times a week for six months. The measurement of hematocrit and hemoglobin were done using CBC cell counter (Sysmex KX21). Other data were extracted from medical records. ResultL: In the current study, the mean age of patients in the intervention and control groups was 9.15±1.53 and 8.35± 6.90 years old, respectively (p=0.9). The mean hematocrit level in the intervention and control groups was 28.05± 4.06 and 23.45± 3.22 %, respectively (P<0.001). The mean hemoglobin level in the two groups was 9.15± 1.53 and 7.65± 1.23 g/dL respectively (p=0.002). The mean hematocrit level before and after the intervention was 25±3.71 and 28.05±4.06 %, respectively. The mean hemoglobin levels before and after therapy were 7.9±1.52 and 9.15±1.53 g/dL, respectively. Conclusion: According to the findings, hemoglobin and hematocrit increased in thalassemia intermedia patients taking erythropoietin. Therefore it seems that recombinant erythropoietin can be helpful in these patients.

Evaluation of NF1 and RASA1 gene expression in endometriosis

Background

Endometrios affecting 6-10% of women of reproductive ages around the globe. Important pathways, including the MAPK and PI3K / Akt pathways, have been identified in the disease. The NF1 and RASA1 genes inactivate Ras by their own GTPase activity and controlled the high activity of these pathways.

Objective

In this study, we measured NF1 and RASA1 gene expression in the endometrial tissues of patients (eutopic and ectopic tissues) compared to the control samples.

Materials and methods

In our study, tissue samples were collected from 15 patients with endometriosis and 15 healthy women. We used quantitative polymerase chain reaction (qRT-PCR) to measure the NF1 and RASA1 gene expression levels in these samples.

Results

We observed a significant decrease in the expression level of the NF1 gene in both eutopic and ectopic samples of endometriosis patients compared to control samples, while the expression of the RASA1 gene was significantly reduced only in ectopic tissues.

Effective indicators of hospital resilience in epidemic conditions

Introduction: The concept of hospital resilience means "the ability of a hospital to withstand, absorb and respond to catastrophic shocks ."Humans have been plagued by a variety of disasters throughout their lives, including emerging diseases, and have suffered irreparable loss. Hospitals play a key role in crisis management and control of epidemics, and therefore the hospitals readiness to continue medical services in crises is of particular importance. Therefore, the present study was conducted with the aim of obtaining effective indicators on hospital resilience in epidemic conditions. Materials and Methods: A qualitative study was conducted to identify the indicators. The main method of data collection was semi-structured interviews with experts and also review of extensive texts. Finally, using qualitative content analysis method and with the help of MAXQDA software, the main dimensions, indicators and below Indicators were extracted. Results: According to the results, the main dimensions included: 3 dimensions (management and leadership, readiness and adaptability capacity ) and the main indicators include 11 indicators (manpower management, support services management, disease management, cohesion and structuring, redundancy, knowledge management, Organizational culture, service delivery, infection prevention and control, environmental health, recovery). The number of sub-main indicators is also 43. Conclusion: In order to improve resilience, hospitals can focus on the identified indicators and monitor and improve them. Correction and improvement of effective indicators will lead to the promotion of resilience and effective management and control of pandemic crises in hospitals.

The Comparison of The Efficacy of Photobiomodulation and Ultrasound in the Treatment of Chronic Non-specific Neck Pain: A Randomized Single-Blind Controlled Trial

Introduction: Chronic neck pain is a common complaint among office workers. The aim of the present study was to compare the efficacy of a high-intensity laser and physiotherapy in office workers who were diagnosed with chronic non-specific neck pain. Methods: This study was a single-blind randomized controlled trial, with parallel allocation. Sixty office workers with chronic neck pain, aged between 25 and 55 years, participated in the study. The participants were randomly divided into two groups: photobiomodulation (by a high-level laser) and physiotherapy. Visual analogue scale (VAS), Neck Disability Index (NDI), Neck Pain and Disability Scale (NPDS) and Bournemouth Questionnaire (BQN) were completed on three occasions (before, immediately and 2 weeks after the intervention) to assess and compare the efficacy of the high-intensity laser and physiotherapy in neck pain. Data were analyzed by SPSS 23 software using the chi-square test, Student's t test, multivariate tests, and Fisher's exact test. Results: The mean age of the participants was 37.53±9.52 and 41.16±7.85 years in physiotherapy and laser therapy respectively. The VAS score and NDI scores decreased after both kinds of interventions, and the effect of photobiomodulation was significantly higher than physiotherapy (P < 0.001). Both treatment modalities significantly affect different aspects of chronic neck pain assessed by NDPS and BQN questionnaires and the effect of photobiomodulation was more prominent than physiotherapy. Conclusion: The findings of this study showed that photobiomodulation and physiotherapy can reduce chronic neck pain and its different aspects and the effect of laser therapy was significantly higher than physiotherapy.

Epidemiology of musculoskeletal symptoms, rheumatologic disorders, and disability in the Zoroastrian population in Yazd, Iran: a WHO-ILAR COPCORD study (stage 1)

Background

The purpose of this study was to determine the prevalence of musculoskeletal complaints, rheumatologic diseases, and disability among the Zoroastrian population in Iran.

Methods

The city of Yazd, in central Iran was selected for this study, with the highest population of Zoroastrians in Iran. Subjects were selected by cluster sampling of 9 neighborhoods populated with Zoroastrians. Subjects ≥15 years old were interviewed by trained interviewers in their houses. The validated Farsi translation of Community Oriented Program for the Control of Rheumatic Disease (COPCORD) Core Questionnaire (CCQ) was used for this study. Subjects with musculoskeletal complaints (pain, stiffness and/or swelling) were examined by a rheumatologist. Laboratory tests and radiographic exams were performed when deemed necessary.

Results

Two-thousand subjects were interviewed during a 12-month period, of which 956 were male, and 1044 were female. The mean age was 41.1 ± 18.3 years (95%CI: 40.3–41.9). 36.9% of the subjects had university-level education. In the 7 days prior to the interview, 27.6% of the subjects had musculoskeletal complaints, with the knee, dorsolumbar spine, and shoulder being the most common sites of complaints. The most common rheumatologic diagnoses were osteoarthritis (21.5%) and low back pain (10.3%). Rheumatoid arthritis was diagnosed in 1.2% of the subjects.

Conclusions

The epidemiology of musculoskeletal complaints and rheumatologic disorders was inconsistent with previous COPCORD studies in Iran, with a lower prevalence of musculoskeletal complaints in general, lower rates of Behçet and lupus, and a higher prevalence of rheumatoid arthritis. The findings of this study can be for development of better prevention, screening, and treatment programs for the vulnerable population of Zoroastrians in Iran.

Technological characteristics of inulin enriched gluten-free bread: Effect of acorn flour replacement and fermentation type

Textural, physicochemical, and sensory characteristics of rice-based gluten-free bread in the presence of acorn flour; inulin and different fermentation type (yeast starter fermentation [Y] or mixed fermentation based on sourdough [MF-SD]) were investigated. Acorn flour was added to replace rice flour at a proportion of 10, 30, and 50% W/W. Furthermore, the mixture flour was replaced by inulin as a functional prebiotic ingredient at 10% W/W. Considering results obtained at this study, using mixed fermentation based on sourdough and inulin at 10% W/W provide the structure able to restore gases through baking process at formulations containing acorn flour at 30% W/W (A30R70SL). The highest specific volume (1.47 ± 0.04 cm3 g-1) and the lowest hardness (40.97 ± 0.87 N) are observed in A30R70SL which seems to be induced by its potential to form gel. Acorn flour substitution level at 50% W/W adversely influenced the technological characteristics of final product and its perception by the consumer. Acorn flour substitution up to 30% W/W is preferred by the consumer which is attributed to its potential role to improve the unpleasant pale color of rice-based gluten-free products. A negatively significant correlation has been observed between the color perception by the consumer and crumb lightness (r = -.493, p ≤ .05).

Maternal and neonatal outcomes among pregnant women with different polycystic ovary syndrome phenotypes: A cross-sectional study

Background

Pregnancy is a process associated with various metabolic and hormonal changes, and polycystic ovary syndrome (PCOS) can affect this process.

Objective

This study aimed to evaluate and compare the maternal and neonatal outcomes among pregnant women with different polycystic ovary syndrome phenotypes.

Materials and Methods

In this cross-sectional study, 200 pregnant women with PCOS according to the 2003 ESHRE/ASRM criteria were categorized into four phenotype groups (A-D). The maternal outcomes include gestational diabetes mellitus, pregnancy-induced hypertension, premature rupture of membranes, preterm labor, small-for-gestational age birth, intrauterine growth restriction, intrauterine mortality, preeclampsia, abortion, amniotic fluid disorders, delivery method, and cause of cesarean section were studied between groups. Additionally, neonatal outcomes such as neonatal weight, neonatal recovery, 5-min Apgar score, neonatal icter, the need for NICU admission, the cause of hospitalization, and infant mortality rate were investigated and compared among the groups.

Results

According to the results, phenotype D (37%) was the most common phenotype among the participants. The risk of gestational diabetes was more common in phenotype A than in the other phenotypes, whereas pregnancy-induced hypertension was most common in phenotype B. No significant differences were observed in the neonatal complications among the PCOS phenotypes.

Conclusion

Considering the higher risk of gestational diabetes mellitus and pregnancy-induced hypertension in PCOS phenotypes A and B, women with these phenotypes need more precise prenatal care.

The prevalence of musculoskeletal discomforts and its relation with work posture in Carpet Weavers, Boshruyeh City

Introduction: Carpet industry is one of the most important, dangerous and traditional industries in Iran. Non-Ergonomic factors such as non-standard work tools, inappropriate physical postures, long hours of work and insufficient rest of carpet weavers can lead to musculoskeletal disorders. The purpose of this study was to determine the prevalence of musculoskeletal discomfort and its relationship with posture in rural carpet weavers in Boshruyeh city.   Methods: This study is descriptive, analytical and cross-sectional. The sampling method was census-based and included all rural carpet weavers in Boshruyeh city who were active at least 6 months prior to the beginning of the study and were willing to cooperate (62 people). In order to investigate musculoskeletal discomforts, used from Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) and for posture assessment, The Occupational Repetitive Action Index (OCRA) method was used. The collected data by using SPSS software IBM 24 (Pearson correlation test) was analyzed.   Results: The results showed that 98.39% of the workers felt discomfort at least in one of the 20 assessed regions. The most common discomfort of carpet weavers was 72.88% in the lower back region and the lowest incidence of discomfort was 9.68% in the hip/buttocks. There was a significant statistical relationship between scores of musculoskeletal discomforts in 11of 20 assessed regions with OCRA score (p <0.05), There was also a significant statistical relationship between age, work hours and work experience with CMDQ score (p <0.05).   Conclusions: It seems Insufficient rest, Repetitive work, and incorrect posture are of factors affecting the musculoskeletal discomfort.observe the principles of ergonomics, especially having proper postures and regular rest along with stretching can be helpful in reducing the incidence of discomfort and musculoskeletal disorders.

Long-term outcome of endometrial ablation therapy with Cavaterm Thermal Balloon in patients with abnormal uterine bleeding

Objective

The purpose of this study was to evaluate the long-term outcome of endometrial ablation (EA) therapy with Cavaterm Thermal Balloon in patients with abnormal uterine bleeding (AUB).

Material and Methods

The retrospective cross-sectional study was performed on 209 patients who referred to Shahid Sadoughi Hospital in Yazd, Iran between March 2010 and September 2017 with AUB undergoing EA therapy. The data was collected by a questionnaire from the medical records of patients and phone call. The primary and secondary outcomes post EA therapy (from six months to seven years post-operatively) were assessed in patients.

Results

The mean age of participants was 45.9±5.9 years and the mean follow-up duration was 21.2±13.2 months. The rate of treatment response was 95% in the first six months and 92.1% thereafter. The prevalence of amenorrhea was 41.2%. The patient satisfaction rate at the end of follow-up duration was 81.3%. Dysmenorrhea completely resolved in 32.6%. Moreover, 1.4% of patients became pregnant during follow-up. By the end of follow-up, four (1.9%) patients had a hysterectomy due directly to treatment failure.

Conclusion

This study showed that EA surgery with Cavaterm Thermal Balloon was an effective treatment for AUB. The procedure was safe and was associated with a very low rate of postoperative adverse events. The patient satisfaction rate was favorable.

Bayesian approach for cure models with a change-point based on covariate threshold: application to breast cancer data

In this study, a Bayesian approach was suggested to estimate a change-point according to a covariate threshold when some patients never experienced the event of interest. Gibbs sampler algorithm with latent binary cure indicators was used to simplify the implementation of Markov chain Monte Carlo method. Then, the accuracy of new model was demonstrated by simulation studies to compute the point and interval estimates of parameters. Finally, an effective threshold was suggested in age at surgery time to experience the metastasis when the model was applied for a data set of breast cancer patients.

Comparing the Recurrence of Vulvovaginal Candidiasis in Patients Undergoing Prophylactic Treatment with Probiotic and Placebo During the 6 Months

This is a randomized, double-blind, clinical/comparative trial study, involving the recurrence of vaginal candidiasis (VVC) after initial treatment with oral fluconazole in patients undergoing prophylactic management with a probiotic and placebo for 6 months. Fifty-nine VVC patients who were diagnosed based on their history, physical examination, and culture of vaginal discharge were initially treated by a single dose of 150 mg fluconazole. According to the table of random numbers, the sample was divided into two groups. The patients from one group took probiotics, while those from the other group took a placebo, with all of them being continuously monitored for 6 months. The patients complaining of vaginal candidiasis symptoms, such as burning, pruritus, and a vaginal (curd-like) discharge, were examined and the discharge was cultured for candida. The positive cultures were considered to be recurring for the patients in each group. Thirty-one cases from the placebo group and 28 cases from the probiotic group were carefully observed. In total, the 6-month recurrence in the control group was eleven (35.5 %) and in the research group was two (7.2 %). The results from Fisher's exact test for the value p = 0.01 and OR 0.14 95 % CI (0.028-0.7) showed significant recurrence in the placebo group. The findings demonstrated that taking probiotics withazole antifungal drugs could be highly effective in treating VVC, resulting in a lower recurrence rate as well.

Predictors of Adverse Outcomes of Patients with Chest Pain and Primary Diagnosis of Non-Cardiac Pain at the Time of Discharge from Emergency Department: A 30-Days Prospective Study

Background

Chest pain is a common symptom for referring patients to emergency departments (ED). Among those referred, some are admitted to hospitals with a definite or tentative diagnosis of acute coronary syndrome and some are discharged with primary diagnosis of non-cardiac chest pain. This study aimed at investigating 30 days' adverse outcomes of patients discharged from ED of a major heart center in Iran.

Methods

Out of 1638 chest pain admissions to the centre during 2010–2011, 962 patients (mean age= 50.9±15.9 years) who were admitted to Afshar Heart Center's ED with chest pain as their chief complaint, and discharged with primary diagnosis of non-cardiac chest pain, were followed for any adverse cardiac events 30 days post discharge. The adverse events were: unstable angina, non-ST-elevated myocardial infarction (NSTEMI), ST elevated myocardial infarction (STEMI), coronary revascularization (percutaneous angioplasty, coronary artery bypass grafting) and death.

Results

Adverse cardiac events, including acute coronary syndrome (ACS), revascularization and death were observed in 30 patients (3.1%) including: acute MI n=5 (0.5%, sudden cardiac death inn=1 (0.1%, coronary revascularization in n=8 (0.8%) and hospitalization due to unstable angina/NSTEMI in n=16 (1–7%). Adverse events were seen more frequently in patients with history of hypertension, dyslipidemia and previous coronary artery disease. In univariate analysis, the chance of postdischarge adverse cardiac events was higher in patients with hypertension (OR=9.36, CI=3.24–27.03), previous coronary artery disease (OR= 3.8, CI=1.78–8.0), dyslipidemia (OR=3.5, CI=1.7–7.38) and discharge against medical advice (OR=2.85, CI= 1.37–5.91).

Conclusion

The extent of adverse cardiac events in patients with a primary diagnosis of non-cardiac chest pain within 30 days of discharge was significant, mandating nation-wide registries to provide better care for these patients.

Independent and joint effects of serum 25-hydroxivitamin D and calcium on breast cancer ratio in an Iran population: A cross-sectional study

BACKGROUND

It has been suggested that Vitamin D and calcium have protective effects against breast cancer. The results about breast cancer and serum Vitamin D and calcium levels are still controversial, indefinite, and insufficient to determine the amount of nutritional needs. Thus, we investigated the association between serum 25-hydroxyvitamin D(25-OH-D) and calcium on the ratio of breast cancer at diagnosis time.

MATERIALS AND METHODS

We carried out a hospital-based cross-sectional study in a population of Iran. It comprised 57 breast cancer cases, who were newly diagnosed, and 85 controls in 2013. The serum 25-OH-D and calcium levels were measured.

RESULTS

There was not any significant association between 25-OH-D and breast cancer ratio. Odds ratio (OR) comparing the highest quartile to the lowest quartile was 1.03(95% confidence interval[CI] 0.33-3.22, P-trend 0.95). Having sufficient (>75 nmol/L) serum 25-OH-D levels compared to insufficient serum 25-OH-D levels was not associated with a significantly decreased ratio of breast cancer (OR 0.55, 95% CI 0.23-1.29, P = 0.17). Furthermore, an association between calcium and breast cancer did not get statistical significance (OR 0.51, 95% CI 0.17-1.49, P-trend 0.31). The joint effect was negative interaction.

CONCLUSION

Vitamin D and calcium do not act on decreasing ratio of breast cancer. Decreasing ratio of breast cancer in relation to serum calcium and Vitamin D level at diagnosis time needs more assessments.

Flatfoot and obesity in school-age children: a cross-sectional study

Childhood obesity exerts abnormally high stresses on developing foot structures which can lead to structural deformity of the foot. Screening for foot problems in children with overweight helps detect interior risks restricting normal lifestyle in these individuals. The purpose of this study was to investigate the effects of excess weight on the structure and function of the developing foot in students aged 7-14 years. A total of 667 participants were recruited for this cross-sectional study via a multi-level cluster sampling method (randomization was used within each cluster). All subjects (340 boys and 327 girls) attended primary and secondary schools in Isfahan City, Iran. The children's feet were evaluated using clinical assessments and footprint-based measures whilst fully weight bearing. Significant differences were observed in the frequency of flatfoot between normal weight, overweight and obese groups (P < 0.001); participants who were more overweight had flatter feet. Children with higher weight also had a more pronated heel, less dorsiflexion range and higher reported pain within physical activity. This study indicated that childhood obesity is associated with structural foot and ankle deformities and activity-related foot pain.

Clinicopathologic characteristics and survival of patients with bone metastasis in Yazd, Iran: a cross-sectional retrospective study

To evaluate the clinico-pathological and survival characteristics in patients with bone metastasis. This cross-sectional study was conducted on patients with bone metastasis who referred to Shahid Ramezanzadeh radiation oncology center. For all of the patients studied, demographic and survival information was recorded. SPSS was used to analyze the data. In this study, 89 men (53.3%) and 78 women (46.7%) with bone metastasis were examined. Most of the patients were in the 66 to 87 age range. Breast cancer was the most common type of cancer in women and prostate cancer was the commonest in men. In most patients, pain was the first manifestation of the disease, and the spine has been most frequently involved areas. The disease was diagnosed by isotope bone scan in the most cases. The mean survival was 31.1 months for patients with breast cancer, 12.9 months for patients with prostate cancer, 13.7 months for patients with lung cancer and the overall survival was 22.5. There was only a meaningful correlation between sex, type of cancer, radiation dose, and survival in patients. We found that age was more effective than the variable of cancer type in survival of patients with bone metastasis. The prognosis of patients with bone metastasis in our center is fair. There was a significant correlation between sex, type of cancer, radiation dose, and survival. Cox proportional hazards model showed that age was a predictor of death.

Hospitals' readiness for clinical governance implementation in educational hospitals of yazd, iran

BACKGROUND

Clinical governance is a systematic approach to maintaining and improving the quality of patient care. This study aimed to assess some Iranian educational hospitals' readiness for clinical governance implementation through the organizational climate.

METHODS

It was a cross-sectional study that used the Clinical Governance Climate Questionnaire (CGCQ) in three educational hospitals in Yazd, a city in central Iran, in 2012. A total of 186 personnel contributed to the study. Data were analyzed using SPSS version 16. Descriptive statistics and the Kruskal-Wallis test were used for data analyses.

RESULTS

The mean scores of the clinical governance climate in Shahid Sadoughi, Shahid Rahnemoon and Afshar hospitals were 2.63±0.29, 2.58±0.32, and 2.68±0.29. The mean scores of quality improvement planning and change, quality improvement integration and motivation, clinical risk management and climate of blame and punishment, organizational learning, and training and development (T&D) opportunities for learning in the studied hospitals were 2.21±0.49, 2.80±0.40, 2.76±0.40, 2.91±0.54 and 3.06±0.72, respectively.

CONCLUSION

The results of this study showed that the educational hospitals' climate should be more supportive for successful implementation of clinical governance.

The effect of iron supplement on children with euthyroid goiter: a randomized placebo-controlled clinical trial

BACKGROUND

Endemic goiter is present in most parts of Iran. Iron deficiency adversely affects the physiology of thyroid. The initial steps of thyroid hormone synthesis are catalyzed by thyroperoxidases and are dependent on iron. In many developing countries, children are at high risk of both goiter and iron deficiency anemia. In addition, iron deficiency may alter central nervous system control of thyroid metabolism; andalso Iron-deficiency anemia decreases plasma concentrations of thyroxine and triiodothyronine.

MATERIAL AND METHOD

We conducted a randomized, double-blind,controlled trial in 2-12-y-old children with euthyroid goiter and without iron-deficiency anemia. THE CHILDREN WEREDIVIDED INTO TWO GROUPS: The Patients who were under treatment with ferrous-sulphat and controls .active treatment consisted of iron supplementation was administered orally with a dose of 2 mg/kg day. The duration of active treatment was 12 weeks.

RESULTS

In this study 40 children (female: 22, male: 18) were divided into two groups randomly. (20 patients in each group).There were no significant differences at baselines between groups with regard to gender, age and weigh. At the end of the study, the reduction of more than one grade of goiter was significant between iron-treated and placebo groups. In treatment group, 16 patients (80%) had decreased grade of goiter, while in the control group, 3 patients (15%) had grade reduction(P-value<0.001).

CONCLUSION

At the end of the study, decrease of more than one grade of goiter had significant differences between iron-treated and control groups.

Zoroastrians Support Oocyte and Embryo Donation Program for Infertile Couples

Background

The main goal was to evaluate the attitudes and knowledge of Zoroastrians living in Iran towards oocyte donation (OD) and embryo donation (ED) program.

Methods

This cross sectional study consisted of 318 Zoroastrians (n=175 for OD and n=143 for ED) of both sexes. The questionnaire form comprised two parts of general demographic characteristics of the participants and twenty multiple-choice questions about attitude and knowledge of participants towards OD and ED. For statistical analysis, the chi-square test was applied for comparison of data generated from ED and OD groups.

Results

Majority of the participants supported OD (69.7%) and ED (71.3%) for infertile patients. In addition, 40% and 42% preferred donation program (OD and ED, respectively), compared to adoption. About 60% of the respondents believed that the donors have no right to find the child and claim it as their own. In addition, more than half of the respondents thought that the recipients of oocyte/embryo should never know the name and address of the donors. More than half of the participants did not know whether their religion accepts donation program or not. Approximately, 80% of respondents supported psychological counseling for both donors and recipients. Moreover, about 56% of the participants necessitated the advertisement on OD/ED program in the mass media.

Conclusion

Our preliminary data showed that Zoroastrians supported both OD and ED program equally for infertile couples.

Cancer in pregnancy: a 10-year experience in shahid sadoughi hospital, yazd, iran

INTRODUCTION

Although occurrence of cancer during pregnancy is rare, it leads to high morbidity and mortality in both mother and fetus. Recent trends in prolongation of child-bearing age have made cancer-associated pregnancies more frequent than past. As yet there are few documents concerning cancer and its related treatment outcomes during pregnancy. This study aimed at describing clinical characteristics of pregnant women with cancer in the Shahid Sadoughi hospital in Yazd, Iran.

MATERIALS AND METHODS

Case series were reviewed retrospectively, which included 19 pregnant women diagnosed with cancer in Shahid Sadoughi hospital from 2002 to 2012. Data collected comprised demographics, pregnancy characteristics and outcomes, type of cancer, clinical stage, treatment and oncological.

RESULTS

From 17 pregnant women with cancer, 4 women had gynecologic cancers and 13 had non-gynecologic cancers. The Following tumors were observed: breast [6], acute myeloblastic leukemia [3], uterine cervix carcinoma [3], ovary [1], chronic myelogenous leukemia [1], lymphoma [1], papillary carcinoma of thyroid [1], and pseudopapillary carcinoma of pancreas [1]. The mean age of patients was 30.6 years, and the mean gestational age at diagnosis was 21.1 weeks. Surgical treatment was performed in 3 patients, 6 patients were treated by chemotherapy, and in 3 by both.

DISCUSSION

Although cancer during pregnancy is uncommon, it is considered an important problem due to unsuitable maternal and fetal outcomes and lack of standard management guidelines. Our cases represent examples of feasible or justifiable managements for them.

Five-Year Status of Malaria (a Disease Causing Anemia) in Yazd, 2008-2012

BACKGROUND

Yazd province which is the host of local and foreign immigrants may be faced with contacting malaria. Plasmodium falciparum malaria remains a major cause of mortality throughout in the tropical regions of the world. Pthophysiologic mechanisms of anemia in malaria is such as direct invasion of Red cells, anemia of chronic disease hypersplenism, Hemophagocytic syndrome and erythrophagocytosis, dyserythropoirsis, immune haemolysis and cytokine deregulation anemia of chronic disorder is characterized by moderate to mild normocytic, normochromic anemia along with microcytic hypochromic cells. Malaria occurs predominantly in children in the first three years of life. The purpose of this study was Demographic study of malaria during 2008 to 2012 in Yazd.

MATERIALS AND METHODS

This study was an analytic-descriptive and manner descriptive study. All episodes (Imported Malaria) of disease from 2008 to 2012 which were documented in Yazd Central Health Service were carefully studied and reported.

RESULTS

A total of 206 confirmed reported malaria patients from 2008 to 2012 were studied; Plasmodium (P). vivax species was mostly, 187(90.78%) and Plasmodium (P). Malaria species was Lesley, 1(0.49%). The mean age groups, accommodation with local malaria and years of reported outbreaks of different strains of the parasite conducted by Fisher exact Test, showed no significant difference(P-value>0.05), but the mean of foreigner immigrants of outbreaks of different strains of the parasite conducted by Fisher exact Test, showed significant difference (P-value= 0.01).

CONCLUSION

Although malaria has been designed on elimination program in Iran, but in the province of Yazd is reported imported malaria and its importance in causing anemia and other blood disorders is not negligible.

The effect of educational intervention on decreasing mothers' expressed breast milk bacterial contamination whose infants are admitted to neonatal intensive care unit

BACKGROUND

Various reasons accounted for the infection of infants kept at Neonatal Intensive Care Unit (NICU). Expressed breast milk may be regarded as a source of infection in infants. This study investigated the source of bacterial contamination and the impact of educational interventions on the contamination of mothers' expressed breast milk (EBM) level whose infants are hospitalized at NICU.

METHODS

Fifteen mothers used to express breast milking their infants admitted at NICU, involved in this study was conducted during October 2011-March 2012. Samples taken from hands, breast, pumps, breast milk, and milk storage containers and therefore 244 samples were prepared by sterile cotton swab and cultured on Blood Agar and EBM. After presenting enough training to mothers, cultures of the same positions were carried out again. Only those samples proved infected that number of their bacterial colonies exceeded 104 cfu / ml or even there was a growth of pathogenic organism.

RESULTS

Before intervention 80% of mothers had infected by at least one sample that reduced to 36% after the intervention. Before intervention 25.4% of samples were contaminated; however after intervention, it reduced to 8.2%. The main source of contamination was milk containers and pumps; moreover, Pseudomonas, E-coli, and Klebsiella were among the most common bacteria of samples' contamination.

CONCLUSION

The possibility of EBM contamination was relatively high but educational interventions might reduce the risk of prevalence.