Prevalence of depressive symptoms and suicidal behaviors among Iranian high school students: A systematic review and meta-analysis

AIM

The objective of this meta-analysis was to determine the prevalence of depressive symptoms and suicidal behaviors among high-school students in Iran.

MATERIALS AND METHODS

A comprehensive search strategy was conducted in the following original databases: PubMed, Web of Science (ISI), Scopus, Psycinfo, and national databases, including the Scientific Information Database (SID) and MagIran, from January 1988 through January 2023. Studies that reported the prevalence of depressive symptoms and suicidal behaviors among high school students in Iran were included. Two investigators extracted all relevant data independently. For deriving mean prevalence rates, random-effects meta-analyses were used. We assessed the quality of studies by the Joanna Briggs Institute (JBI).

RESULTS

Total of 67 studies (45,798 participants) were included in the syntheses on depressive symptoms and suicidal ideation. For depressive symptoms, the mean prevalence rate was 48 % (40 %, 55 %). 2804 participants were enrolled for assessing of the prevalence of suicide ideation, and the mean prevalence rate was 21 % (6 %, 36 %). The meta-analysis pooling of the prevalence estimates of suicide attempts was 18 % (15 %, 20 %).

CONCLUSIONS

Approximately half of the high school students experience depressive symptoms and, astonishingly, one in five high school students experiences suicidal ideation, so to identify strategies for preventing and treating depressive symptoms and suicidal behaviors in this special population, further research and policymaking are urgently needed.

The prevalence of thyroid disorders in COVID-19 patients: a systematic review and meta-analysis

OBJECTIVES

To conduct a systematic review and meta-analysis to evaluate the prevalence of thyroid disorders in COVID-19 patients.

DATA SOURCES

Scopus, PubMed, ISI Web of Science, and Google Scholar databases were used in this review. We also consider the results of grey literature.

STUDY SELECTIONS

Cohort, cross-sectional, and case-control studies were included.

DATA EXTRACTION AND SYNTHESIS

The required data were extracted by the first author of the article and reviewed by the second author. The Pooled prevalence of outcomes of interest was applied using the meta-prop method with a pooled estimate after Freeman-Tukey Double Arcsine Transformation to stabilize the variances.

OUTCOMES AND MEASURED

The different thyroid disorders were the main outcomes of this study. The diseases include non-thyroidal illness syndrome, thyrotoxicosis, hypothyroidism, isolated elevated free T4, and isolated low free T4.

RESULTS

Eight articles were included in our meta-analysis(Total participants: 1654). The pooled prevalence of events hypothyroidism, isolated elevated FT4, isolated low FT4, NTIS, and thyrotoxicosis were estimated (Pooled P = 3%, 95% CI:2-5%, I2: 78%), (Pooled P = 2%, 95% CI: 0-4%, I2: 66%), (Pooled P = 1%, 95% CI: 0-1%, I2: 0%), (Pooled P = 26%, 95% CI: 10-42%, I2: 98%), and (Pooled P = 10%, 95% CI: 4-16%, I2: 89%), respectively.

CONCLUSION

Thyroid dysfunction is common in COVID-19 patients, with a high prevalence of non-thyroidal illness syndrome (NTIS) and thyrotoxicosis. Our meta-analysis found a 26% prevalence of NTIS and a 10% prevalence of thyrotoxicosis.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022312601.

Efficacy and safety of add-on Viola odorata L. in the treatment of COVID-19: A randomized double-blind controlled trial

ETHNOPHARMACOLOGICAL RELEVANCE

Severe Acute Respiratory Syndrome (SARS) due to the novel coronavirus has become the highest priority that threatens human health. This situation demands widespread vaccination and the innovation of new therapeutic methods. Despite drug discoveries, the need for approving new medicaments is felt because of adverse effects and lack of efficacy. Several medicinal plants including Viola odorata L. are recommended in traditional Persian medicine for alleviating respiratory infection symptoms. Recent studies showed anti-inflammatory, antioxidant, anti-asthmatic, antitussive, analgesic, and antibacterial activities of sweet violet. These enhance respiratory functions, reduce pulmonary inflammation, and decline mucous membrane edema. This study aimed to evaluate the efficacy of sweet violet syrup in alleviating the manifestations of COVID-19 infection.

MATERIAL AND METHODS

A randomized parallel-group double-blind controlled trial was conducted at Al-Zahra general hospital, Isfahan, Iran. A total of 108 outpatients were enrolled in the study. The patients were randomly allocated to intervention and placebo groups, with 54 patients in each group. The allocation was concealed using sealed opaque envelopes. The intervention group received violet syrup and the control group received placebo syrup, an add-on to the conventional treatment. The outcomes were COVID-19 manifestations, such as dyspnea, cough, myalgia, headache, and diarrhea, considered as outcomes of the study and were evaluated twice using a visual analog scale before the intervention and after 7 days, at the end of the study. Patients were followed daily by phone calls to monitor proper drug consumption and possible side effects.

RESULTS

No significant difference was between groups regarding demographic characteristics and vital signs before and after the treatment. Although all symptoms have improved significantly in both groups, patients who received violet syrup recovered faster and the mean severity scores of cough (P = 0.025), myalgia (P = 0.036), headache (P = 0.037), and diarrhea (P = 0.044) decreased greater in comparison to control group.

CONCLUSION

This study, the first clinical trial on the effectiveness of Viola odorata on SARS-CoV-2 patients, showed that Viola odorata L. effectively controls prevalent manifestations of COVID-19 including cough, myalgia, headache, and diarrhea. Regarding this survey, the violet syrup can be mentioned as a complementary treatment for viral influenza-like infections in which cough, myalgia, headache, and diarrhea are prominent.

Demographic, Epidemiologic, and Clinical Characteristics of Human Monkeypox Disease Pre- and Post-2022 Outbreaks: A Systematic Review and Meta-Analysis

(1) Background: In early May 2022, an increasing number of human monkeypox (mpox) cases were reported in non-endemic disparate regions of the world, which raised concerns. Here, we provide a systematic review and meta-analysis of mpox-confirmed patients presented in peer-reviewed publications over the 10 years before and during the 2022 outbreak from demographic, epidemiological, and clinical perspectives. (2) Methods: A systematic search was performed for relevant studies published in Pubmed/Medline, Embase, Scopus, and Google Scholar from 1 January 2012 up to 15 February 2023. Pooled frequencies with 95% confidence intervals (CIs) were assessed using the random or fixed effect model due to the estimated heterogeneity of the true effect sizes. (3) Results: Out of 10,163 articles, 67 met the inclusion criteria, and 31 cross-sectional studies were included for meta-analysis. Animal-to-human transmission was dominant in pre-2022 cases (61.64%), but almost all post-2022 reported cases had a history of human contact, especially sexual contact. The pooled frequency of MSM individuals was 93.5% (95% CI 91.0-95.4, I2: 86.60%) and was reported only in post-2022 included studies. The male gender was predominant in both pre- and post-2022 outbreaks, and the mean age of confirmed cases was 29.92 years (5.77-41, SD: 9.38). The most common clinical manifestations were rash, fever, lymphadenopathy, and malaise/fatigue. Proctalgia/proctitis (16.6%, 95% CI 10.3-25.6, I2: 97.76) and anal/perianal lesions (39.8%, 95% CI 30.4-49.9, I2: 98.10) were the unprecedented clinical manifestations during the 2022 outbreak, which were not described before. Genitalia involvement was more common in post-2022 mpox patients (55.6%, 95% CI 51.7-59.4, I2: 88.11). (4) Conclusions: There are speculations about the possibility of changes in the pathogenic properties of the virus. It seems that post-2022 mpox cases experience a milder disease with fewer rashes and lower mortality rates. Moreover, the vast majority of post-2022 cases are managed on an outpatient basis. Our study could serve as a basis for ongoing investigations to identify the different aspects of previous mpox outbreaks and compare them with the current ones.

Comparison of fine-needle aspiration with fine-needle capillary cytology in thyroid nodules

INTRODUCTION

High false-negative results have been reported for fine-needle aspiration (FNA) cytology in thyroid nodules. Fine-needle capillary (FNC) cytology is an alternative technique that prevents aspiration, reducing tissue damage. This study aimed to compare FNA and FNC in assessing thyroid nodules and in terms of their predictive role in the appropriate diagnosis of malignancy.

METHODS

This is a comparative prospective study conducted on 486 patients. FNA was performed in 235 patients during 2016 and 2017 and FNC in 251 patients during 2018 and 2019. The quality of cytological specimens was compared and then correlated with the final histopathological findings of 39 patients who underwent thyroidectomy.

RESULTS

Both groups were statistically similar regarding age and sex distribution. The FNA technique yielded significantly higher adequate specimens compared with FNC (p<0.001). Abundant blood in the background was found more frequently in the FNA technique (p<0.001). The sensitivity and specificity of FNA for malignancy diagnosis were both 100%, compared with 83.3% and 57.7% for FNC, respectively.

CONCLUSIONS

The two methods, FNA and FNC, did not differ in terms of overall quality. FNA was superior regarding consistency with the histopathological results and the ability to diagnose malignancy.

Long-term Complications of COVID-19 in Nursing Staff; a Retrospective Longitudinal Study

Introduction

Although the lungs are the main target of coronavirus disease (COVID-19), infection is also associated with a high rate of extra-pulmonary complications. This study aimed to evaluate the one-year incidence of long-term COVID-19 complications among the nursing staff.

Methods

This study is a retrospective longitudinal study. All nursing staff working in public hospitals affiliated with Shahid Beheshti University of Medical Sciences who had been affected with COVID-19 were included in the study via convenience sampling method. The patients were recruited from 20_th February 2020 to 20_th March 2021.

Result

1762 nursing staff with a mean age of 35.08 ± 8.02 (Range: 22-66) years were studied (73.5% female). The results showed that among those who reported at least one type of complication, the duration of complications was significantly longer than 1 week and the median was 8 weeks. The findings demonstrated that complications occurred in 65% of infected females. For men, this rate was 62.3%. Generalized pain, anxiety disorders, and skin complications were among the complications that were significantly more common in women than in men. Additionally, the incidence of anosmia, ageusia, anxiety disorders, and skin complications was significantly higher in younger people than in older people. The comparison of complications revealed that nurses were significantly more likely than other occupations to experience respiratory complications, anosmia and ageusia, generalized pain, and skin complications and that outpatients experienced significantly more complications than hospitalized patients.

Conclusion

The one-year cumulative incidence of long-term complications in nursing staff with COVID-19 was 64.3%. The most common complications were respiratory complications, generalized pain, anosmia, and ageusia, respectively.

Tele-medicine and improvement of mental health problems in COVID-19 pandemic: A systematic review

INTRODUCTION

Tele-medicine services have been developed in response to the COVID-19 pandemic, which disrupts mental health services. The present study investigates the effectiveness of telephone-delivered services for psychological disorders in the COVID-19 pandemic.

METHODS

We searched PubMed/Medline, Embase and Cochrane Controlled Register of Trials for relevant clinical studies up to February 1, 2022. Following terms were used: "severe acute respiratory syndrome", "Coronavirus", "Coronavirus infection", "SARS-CoV-2", "COVID-19", "mental disorder", "mental health", "mental health program", "mental health service", "psychiatric service", "telemedicine", "Telehealth", "Tele-health", "Telecare", "Mobile health".

RESULTS

Twelve relevant clinical articles were included in our study. Eight articles were parallel randomized controlled trials (RCTs), two were Quasi-experimental, and one was a multicenter retrospective cohort study. A total of 1900 adults (18 years old or above that) were included. Online telecommunication methods like online apps and videoconference were the most common interventions. The most prevalent measured outcome was levels of anxiety and depression among participants. Eleven out of 12 articles showed a significant association between telemedicine and mental health improvement.

CONCLUSIONS

The included studies in the current systematic review reported the probable efficacy of telemedicine in improving mental health disorders during the COVID-19 pandemic. But it is not possible to determine the best telecommunication method for each mental disorder in different populations and the preference of patients is still face to face therapy. So RCTs in different populations with previous mental disorders or chronic diseases are required to investigate the further telemedicine's efficacy on managing mental problems.

Bedaquiline-containing regimens and multidrug-resistant tuberculosis: a systematic review and meta-analysis

Objective:

Multidrug-resistant tuberculosis (MDR-TB) is a life-threatening infectious disease. Treatment requires multiple antimicrobial agents used for extended periods of time. The present study sought to evaluate the treatment success rate of bedaquiline-based regimens in MDR-TB patients.

Methods:

This was a systematic review and meta-analysis of studies published up to March 15, 2021. The pooled treatment success rates and 95% CIs were assessed with the fixed-effect model or the random-effects model. Values of p < 0.05 were considered significant for publication bias.

Results:

A total of 2,679 articles were retrieved by database searching. Of those, 29 met the inclusion criteria. Of those, 25 were observational studies (including a total of 3,536 patients) and 4 were experimental studies (including a total of 440 patients). The pooled treatment success rate was 74.7% (95% CI, 69.8-79.0) in the observational studies and 86.1% (95% CI, 76.8-92.1; p = 0.00; I² = 75%) in the experimental studies. There was no evidence of publication bias (p > 0.05).

Conclusions:

In patients with MDR-TB receiving bedaquiline, culture conversion and treatment success rates are high even in cases of extensive resistance.

Knowledge, Attitudes, and Practices About COVID-19 Among Healthcare Workers in Iran During the First Wave of the Pandemic

Background and Objective

Investigating the knowledge, attitudes, and practices about the coronavirus disease 2019 (COVID-19) among healthcare workers (HCWs) could be an early step toward identifying their potential educational needs and possible factors involved in misinformation. The objective of this study was to investigate the knowledge, attitudes, and practices about COVID-19 among healthcare workers in Iran during the first wave of the pandemic.

Materials and Methods

The current descriptive-correlational study was conducted during the 1st days of the COVID-19 epidemic in Iran from March 24th to April 3rd, 2020. Participants included all healthcare workers at hospitals, including physicians, dentists, pharmacists, nurses, midwives, laboratory and radiology assistants, and other hospital professionals during the study period. Data were collected through an online self-administrative questionnaire.

Results

The responses of 1,310 participants were analyzed, of which 900 (68.7%) were female. The mean (SD) knowledge score was 25.4 (3.3), 84.7% out of 30. More than 90% of participants correctly recognized the main symptoms, transmission route, and preventive measures for COVID-19. The mean (SD) attitude score was 16.9 (1.1), 93.9% out of 18. Most participants agreed with keeping safe physical distancing, self-isolation upon symptom onset, and city lockdowns. The mean (SD) score for general practices about COVID-19 was 20.8 (2.0), 86.7% of 24.

Conclusion

The knowledge and practice of HCWs were appropriate, and their attitudes were mainly positive. However, there is still room for improvement regarding concerning misinformation and quackeries about COVID-19.

Vaginal bleeding as a sign of Crimean-Congo hemorrhagic fever infection: a case report

Background

Crimean–Congo hemorrhagic fever is a severe vector-borne viral hemorrhagic fever with considerable mortality in humans. This disease is endemic in Afghanistan, and its incidence rate has rapidly increased in recent years. This infection can cause a broad range of hemorrhage manifestations including epistaxis, petechial or purpuric rashes, hematemesis, and melena; however, vaginal bleeding is also reported as a rare manifestation.

Case presentation

We report the case of a previously healthy 30-year-old Afghan female of shepherding occupation, with a sudden onset of fever, generalized body pain, epistaxis, and vaginal bleeding. She was admitted to the hospital after 7 days of symptom manifestation, with predominant signs being high fever, vaginal bleeding, and elevated liver enzymes. The serological test result for Crimean–Congo hemorrhagic fever was positive. She was treated with oral ribavirin and discharged with normal parameters.

Conclusions

People in high-risk professions in endemic areas should be informed that vaginal bleeding is a serious symptom and requires immediate action and, therefore, might be attributed to nongynecologic disorders.

COVID-19: National pandemic management strategies and their efficacies and impacts on the number of secondary cases and prognosis: A systematic review

Background:

Methods:

Results:

Conclusions:

Knowledge, Attitudes, and Safety Practices About COVID-19 Among High School Students in Iran During the First Wave of the Pandemic

Background: School closures have inevitably deprived students of their traditional source of information. The objective of this study was to determine knowledge, attitudes, and safety practices about COVID-19 among high school students in Iran. Methods: This study was conducted from March 24th-April 3rd, 2020. Data were collected via an online-parent-administrative questionnaire. Results: Responses of 704 students were analyzed. Students' mean (SD) knowledge score was 21.5 (4.6) of 30. More than 90% of students knew about the cause of the disease, the routes of transmission, and the most renowned symptoms: dyspnea and cough. Social-and- audiovisual-media were the leading information source. Most students believed that people need to keep safe physical distancing, everyone should isolate themselves upon symptoms onset, people should avoid unnecessary in-person contact with family and friends, and that cities need to go under lockdowns if needed. Students' mean (SD) practice score was 20.2 (2.5) of 24. Most students did not go on a trip, and more than 80% said they would wear facemasks when going outside. Conclusions: High school students' knowledge and safety practices about COVID-19 were somewhat satisfactory, and their attitudes toward the disease were mainly positive. Nevertheless, some witnessed knowledge gaps, negative attitudes, and unsafe practices in the study highlighted the need for targeted education on the pandemic. Social and mass media's significant role and potential could be utilized to battle misinformation and deliver proper knowledge to young adolescents.

Predictors of Intensive Care Unit Admission among Hospitalized COVID-19 Patients in a Large University Hospital in Tehran, Iran

Background: The rapid increase in the spread of COVID-19 and the numbers of infected patients worldwide has highlighted the need for intensive care unit (ICU) beds and more advanced therapy. This need is more urgent in resource-constrained settings. The present study aimed to identify the predictors of ICU admission among hospitalized COVID-19 patients.

Study design: The current study was conducted based on a retrospective cohort design.

Methods: The participants included 665 definite cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) hospitalized in Imam Hossein Hospital from February 20 to May 14, 2020. The baseline characteristics of patients were assessed, and multivariate logistic regression analysis was utilized to determine the significant odds ratio (OR) for ICU admission.

Results: Participants were aged 59.52±16.72 years, and the majority (55.6%) of them were male. Compared to non-ICU patients (n=547), the ICU patients (n=118) were older, had more baseline comorbidities, and presented more often with dyspnea, convulsion, loss of consciousness, tachycardia, tachypnea, and hypoxia, and less often with myalgia. Significant OR (95% CI) of ICU admission was observed for the 60-80 age group (2.42, 95%CI: 1.01; 5.79), ≥80 age group (3.73, 95%CI: 1.44; 9.42), ≥3 comorbidities (2.07, 95%CI: 1.31; 3.80), loss of consciousness (6.70, 95%CI: 2.94, 15.24), tachypnea (1.79, 95%CI: 1.03, 3.11), and SpO2<90 (5.83, 95%CI: 2.74; 12.4). Abnormal laboratory results were more common among ICU-admitted patients; in this regard, leukocytosis (4.45, 95%CI: 1.49, 13.31), lymphopenia (2.39, 95%CI: 1.30; 4.39), elevated creatine phosphokinase (CPK) (1.99, 95%CI: 1.04; 3.83), and increased aspartate aminotransferase (AST) (2.25, 95%CI: 1.18-4.30) had a significant OR of ICU admission. Chest computer tomography (CT) revealed that consolidation (1.82, 95%CI: 1.02, 3.24), pleural effusion (3.19, 95%CI: 1.71, 5.95), and crazy paving pattern (8.36, 95%CI: 1.92, 36.48) had a significant OR of ICU admission.

Conclusion: As evidenced by the obtained results, the predictors of ICU admission were identified among epidemiological characteristics, presenting symptoms and signs, laboratory tests, and chest CT findings.

Endogenous testosterone does not improve prediction of incident cardiovascular disease in a community-based cohort of adult men: results from the Tehran Lipid and Glucose Study

Introduction: To explore the predictive value of testosterone added to the Framingham Risk Score (FRS) for cardiovascular disease (CVD).Methods: Among 816 men, 30-70 years/old, without prevalent CVD, from a community-based cohort (Tehran Lipid and Glucose Study), we assessed the predictive value of testosterone with incident CVD, using three multivariate Cox proportional-hazards models. Model I: FRS variables; model II: Model I plus total testosterone; model III: Model II plus Systolic blood pressure (SBP) * total testosterone (the best fit interaction-term between testosterone and FRS variables). Discriminations and goodness-of-fit were assessed by the C-statistic and the approach of Grønnesby, respectively. p Value <.05 was significant.Results: During 12 years of follow-up, 121 CVD events occurred. In all models, age, treated SBP, smoking, and diabetes were associated with increased CVD (p values <.05). Neither testosterone (models II and III), nor SBP * testosterone (model III) were associated with CVD (p values >.05). The C-statistics for models I, II, and III were 0.819, 0.820, and 0.821, respectively, indicating no significant improvement in the discrimination power. The models' goodness-of-fit did not improve compared with the FRS.Conclusion: Testosterone could not add to the predictive value of FRS for CVD in men, either directly, or through interactions with FRS variables.

Investigation of Crimean-Congo hemorrhagic Fever in Patients Admitted in Antani Hospital, Kabul, Afghanistan, 2017-2018

Background:

Crimean-Congo hemorrhagic fever (CCHF) is the most medically significant hemorrhagic fever. Afghanistan as an endemic region of CCHF has shown a rapidly growing incidence of the CCHF recently, but there is no data on the characteristic of the disease in this country, here we study the epidemiological, clinical, and paraclinical features of this disease in patients with CCHF, based on the collected data from the patients document records from March 2017 to January 2018 in the referral infectious diseases hospital of Afghanistan (Kabul Antani Hospital).

Methods:

A cross-sectional study in 120 patients admitted in Kabul ANTANI hospital was carried out from March 2017 to January 2018. All of the patients were included based on the standard case definitions by World Health Organization.

Results:

Among the 120 patients admitted to CCHF ward, 29 were confirmed by ELISA (18% IgM, 8% IgG+) and the reminders defined as “probable cases” according to WHO case definition. Case fatality rates were calculated as 15% and the overall mean ages were 35 years. The peak of the disease incidence occurred between August and July. Almost all patients reported fever, bleeding, and thrombocytopenia.

Conclusions:

Early detection plays an important role in patients' outcome. Considering that the most cases of the disease are associated with some contacts around Eid-Adha and death attributable to CCHF usually occur in the first 7 days of disease onset, educating population, and especially slaughters, gloves using by housewives during contacts with meat or animal products, and early detection and immediate treatment would have essential roles in primary and secondary prevention of CCHF. Hemorrhagic manifestations and low platelet count provide a clue to early detection of disease. Vaginal bleeding can be a sign of CCHF and needs immediate action.

Evaluation of Diagnostic Values in NCCT and MRI of the Patients With Cerebral Venous or Sinus Thrombosis in Loghman Hakim Hospital in Tehran 2014-2018

Background: Cerebral venous and sinus thrombosis (CVT) is the rare type of stroke, which can be fatal or causes significant morbidity. CVT could cause by multiple etiologies and risk factors and could present with many signs and symptoms such as a headache, seizure or altered mental status. The gold standard for diagnosing CVT is magnetic resonance venography (MRV) or computed tomographic venography (CTV), as these modalities are not available in many health centers and the early diagnosis of this disease improves significantly the outcome of treatment, we evaluated the diagnostic values of CT and magnetic resonance imaging (MRI) in CVT patients. Methods: We compiled and investigated the radiological and clinical records of 92 patients with the final diagnosis of CVT; we observed the sign of thrombosis in 74 patients who had either the non-contrast CT or MRI plus MRV. We statistically analyzed the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, the positive and negative likelihood ratio of these modalities. Results: Our results demonstrated that the sensitivity of CT scan is 60.5%, and its specificity is 66.7%. The positive predictive value of CT is 85%, and its negative predictive value is 34%. Our study demonstrated that the accuracy of CT in diagnosing CVT patients is 62%. Besides our results showed that the sensitivity of MRI in diagnosing CVT is 87%, and the specificity of MRI is 76.9%. Hence the positive predictive value of MRI is 94%, and the negative predictive value is 58%, and the accuracy of this modality is 85% Conclusion: In the absence of gold standard modalities, MRI and CT scan have relatively good diagnostic values, besides MRI is more beneficial between the two, moreover we found that CVT is more prevalent among women and in warm seasons.

Epidemiological, risk factors, clinical, and laboratory features of brucellosis in the Southwest of Iran within 2009–2015

Background:

Brucellosis is a serious disease affecting many individuals in the world and in Iran. The aim of this study was to investigate the epidemiological and clinical features of patients diagnosed with brucellosis in Kohgilouyeh and Boyerahmad province, southwest of Iran.

Methods:

This retrospective descriptive-analytic study included all individuals diagnosed with brucellosis during 2009–2015. The clinical and epidemiological information were gathered from recorded data available in the health center of Kohgilouyeh and Boyerahmad province, the southwest of Iran.

Results:

The total number of patients diagnosed with brucellosis during the study period was 658, of whom, 339 (51.5%) were males. A total of 541 (82.2%) patients resided in rural and tribal areas, and the others lived in urban regions. The mean age of diagnosis was 39.59 ± 17.28 years and the most prevalent age groups were 31–50 (277, 42.1%) and 11–30 (178, 27.1%)-year olds. The most affected groups were housekeeper women (229, 34.8%) and ranchers (152, 23.1%). The relationship between jobs and disease was significant (P < 0.001). Transmission through either suspected dairy products (582, 88.4%) or close contact with infected livestock (537, 81.6%) comprised the most common routes of brucellosis dissemination. The clinical presentation was acute in the majority (581, 88.3%) of the patients. The highest titer for both wright and Coombs wright tests was 1:320. The most frequently administrated drugs were doxycycline and streptomycin (183, 27.8%). The most commonly observed clinical symptom was bone pain (477, 72.5%). Arthritis (12, 1.8%) comprised the most frequent drug-associated complication. Either relapse or treatment failure was recorded collectively in four (0.6%) patients.

Conclusions:

Due to the prevalence of the disease in the nomadic areas, timely detection and control of the disease is essential. Furthermore, livestock vaccination along with educating farmers and physicians about brucellosis can be helpful.

Optimal Cutoff Points for Anthropometric Variables to Predict Insulin Resistance in Polycystic Ovary Syndrome

BACKGROUND

Insulin resistance (IR) is a major cardiometabolic risk factor in females with polycystic ovary syndrome (PCOS). The euglycemic clamp is the gold standard method to measure IR. However, considering the time and cost that it takes, surrogate markers of IR are now widely used. The current study aimed at evaluating the cutoff points of even less invasive anthropometric and body composition variables to predict IR in females with PCOS.

METHODS

The current cross sectional study selected 224 females with PCOS, using Rotterdam criteria, referred to reproductive endocrinology research center; 88 of which were diagnosed with insulin resistance. Receiver operating characteristics curve was used to explore the best cutoff values of each anthropometric and body composition measures. IR was defined as homeostasis model assessment formula greater or equal to 2.6: HOMA-IR = fasting insulin (mU/L) × fasting plasma glucose (mM/L)/22.5.

RESULTS

The highest area under the curve (0.751) was for the multiplication of waist circumference (WC) by body mass index (BMI), as a single index. The highest sensitivity and specificity were for body water (BW) percentage (82% for values greater than 32.85%) and WC (79% for values greater than 88 cm), respectively.

CONCLUSIONS

It was concluded that there were simple anthropometric variables; e.g., WC × BMI, percentage of BW, and WC that could help to estimate IR in clinical settings especially when the gold standard or surrogate markers of IR were unavailable.

Association between Metabolic Syndrome and Health-related Quality of Life among Individuals with Normal and Impaired Glucose Regulation: Findings from Tehran Lipid and Glucose Study

BACKGROUND

Recent studies have shown that metabolic syndrome is associated with poor health-related quality of life (HRQoL). Moreover, it is shown that the prevalence of MetS and impaired glucose regulation, which are shown to have negative impact on HRQoL, overlap. This study aimed to investigate the association between HRQoL and metabolic syndrome (MetS) considering glucose regulation status in a sample of non-diabetic Tehranian adults.

METHODS

This was a cross-sectional study conducted within the framework of the Tehran Lipid and Glucose Study (TLGS).Logistic regression analysis was used to estimate the odds ratio (OR) with 95% confidence interval (CIs) in normal and impaired glucose regulation. Cochran's Mantel-Haenszel test was used to test the homogeneity of the odds ratios for reporting poor HRQoL in those with MetS in two groups of normal and impaired glucose regulation.

RESULTS

Totally, 946 participants were studied. After adjustment for age and educational level in women, MetS showed a significant negative impact on physical functioning and bodily pain in those with impaired glucose regulation and physical role limitation in normal glucose regulation group. In impaired glucose regulation group, women with MetS were more likely to report poor physical functioning (OR: 2.86, CI: 1.02-2.79), and bodily pain (OR: 2.96 CI: 1.09-8.04). In women with normal glucose regulation, poor physical role limitation was significantly associated with MetS. This association was not seen in men in either group. Based on the test of homogeneity of odds ratio, the association between MetS and HRQoL in those with normal and impaired glucose regulation was different in role physical subscale.

CONCLUSIONS

The current study showed that in both normal and impaired glucose regulation groups, MetS was associated with poor physical HRQoL in women but not men.

Quasiperiodic driving of Anderson localized waves in one dimension

We consider a quantum particle in a one-dimensional disordered lattice with Anderson localization in the presence of multifrequency perturbations of the onsite energies. Using the Floquet representation, we transform the eigenvalue problem into a Wannier-Stark basis. Each frequency component contributes either to a single channel or a multichannel connectivity along the lattice, depending on the control parameters. The single-channel regime is essentially equivalent to the undriven case. The multichannel driving increases substantially the localization length for slow driving, showing two different scaling regimes of weak and strong driving, yet the localization length stays finite for a finite number of frequency components.

Development of a new method for sampling and monitoring oncology staff exposed to cyclophosphamide drug

Treatment using cytotoxic drugs is considered to be the most common treatment for cancers. However, the widespread use of these drugs on the health status of the staff at the oncology department has become a great concern. Due to challenges of sampling and analysis of cytotoxic drugs, the aim of this study was to development a novel practical method called Needle trap devices (NTD) for sampling and analysis of personal exposure to cyclophosphamide drug. The sampler consisted of a stainless steel hyper needle gauge 21 of length 9 cm packed with Carboxen 1000 for adsorbing cyclophosphamide. A total of 41 samples of staff's air breathing zone in different wards of the oncology department were taken with the sampler. Samples were analyzed by gas chromatography coupled with electron capture detector (ECD). Linear range concentration was 212-1062 μg/m(3), and LOD and LOQ were 100 and 191 μg/m(3), respectively. The mean inter-day and intra-day coefficient variations for standards within linear range concentration were 8.9 and 4.8 %, respectively. Detectable levels of cyclophosphamide were measured in 31.7 % of air samples. The developed method is user-friendly, quick, and precise for sampling of airborne cyclophosphamide. The results showed that some staff of the oncology department were exposed to the carcinogenic drug and their health were at risk. Since carcinogens do not have a threshold and oncology staffs with their continuous exposure might be at risk, therefore, proper work practice and adequate control measures are essential to ensure their wellbeing.

"Adolescent metabolic phenotypes and early adult metabolic syndrome: Tehran lipid and glucose study"

OBJECTIVE

To investigate the predictive role of adolescent metabolic phenotypes in development of early adult metabolic syndrome (MetS).

STUDY DESIGN

A group of 1446 adolescents (44.8% boys), participants of the Tehran Lipid and Glucose Study, with a mean (SD) of age 14.6 (2.2) years, followed for 10.4 years. Logistic regression models were developed to evaluate the predictive power of different metabolic phenotypes for adult MetS. Moreover, areas under the receiver operating characteristic (ROC) curve were estimated to compare the prediction power of metabolic phenotypes for adult MetS.

RESULTS

The prevalence of MetS was 14.6% (29.7% and 2.4% for adult males and females, respectively) at the end of follow up. The most frequent metabolic phenotype in adolescent was high TGs/low HDL-C (23.7%), while the prevalence of high TGs/high WC was 10.4% and the other phenotypes were less than 10%. After adjustment for baseline BMI Z-Score and BMI change, high TGs/low HDL-C (OR: 1.70, 95%CI: 1.23-2.37), high WC/high BP (OR: 1.75., 95%CI: 1.08-2.84), high BP/low HDL-C (OR:1.68, 95%CI: 1.05-2.60) and high WC/low HDL-C (OR: 2.41, 95% CI: 1.37-4.23) phenotypes were associated with adult MetS. However, their AUCs were significantly lower than overweight or obesity.

CONCLUSION

Some combinations of metabolic abnormalities in adolescence predict early adult MetS, independent of baseline BMI Z-Score and BMI change. However, the discriminative power of these phenotypes was weak, in comparison to adolescent overweight or obesity.

The Diagnostic Accuracy of Frozen Section Compared to Permanent Section: A Single Center Study in Iran

BACKGROUND

The diagnostic accuracy of frozen section as an important source of information in surgical pathology is important not only in the management of surgical patients but also as a measure of quality control in surgical pathology. In this study, we evaluated the diagnostic accuracy of frozen sections over a 6-year period in a teaching hospital in Iran.

METHODS

We retrospectively reviewed frozen sections performed in the Pathology Department of Taleghani Hospital (Shahid Beheshti University of Medical Sciences), Tehran, Iran from 2007 to 2013. The results were compared to the permanent sections to evaluate diagnostic accuracy, sensitivity and specificity, of frozen section test. Discordant cases were reassessed to find the reasons for discrepancy.

RESULTS

A total of 306 frozen section specimens from 176 surgical cases were evaluated. In eleven specimens (3.59%) the diagnoses were deferred. Of the remaining 295 specimens, 6 (2.03%) were discordant and 289 (97.96%) were concordant to permanent diagnoses. Specimens were primarily from the head & neck, thyroid, ovary, parathyroid and lymph nodes. The overall sensitivity, specificity, positive predictive value and negative predictive value of the frozen section compared to permanent section (as gold standard) were 92.95%, 99.55%, 98.50% and 97.80% respectively. Of the 6 discordant diagnoses, two (33.3%) were due to sampling error and four (66.6%) were due to interpretative errors.

CONCLUSION

Frozen section is an accurate and valuable test and can be relied on in surgical managements. The results of this study also confirm that the accuracy of frozen section diagnosis in our institution compares well with internationally published rates.

Saffron ethanolic extract attenuates oxidative stress, spatial learning, and memory impairments induced by local injection of ethidium bromide

Cognitive deficits have been observed in patients with multiple sclerosis (MS) because of hippocampal insults. Oxidative stress plays a key role in the pathophysiology of MS. The aim of this study was to evaluate the effects of Crocus sativus L., commonly known as saffron, on learning and memory loss and the induction of oxidative stress in the hippocampus of toxic models of MS. One week after MS induction by intrahippocampal injection of ethidium bromide (EB), animals were treated with two doses of saffron extract (5 and 10 μg/rat) for a week. Learning and spatial memory status was assessed using Morris Water Maze. After termination of behavioral testing days, animals were decapitated and the bilateral hippocampi dissected to measure some of the oxidative stress markers including the level of hippocampi thiobarbituric acid reactive substances and the activity of antioxidant enzymes such as glutathione peroxidase and superoxide dismutase. Treatment with saffron extract ameliorated spatial learning and memory impairment (P<0.05). Total antioxidant reactivity capacity, lipid peroxidation products and antioxidant enzymes activity in the hippocampus homogenates of EB treated group were significantly higher than those of all other groups (P<0.01). Indeed, treatment with a saffron extract for 7 consecutive days significantly restored the antioxidant status to the normal levels (P<0.01). These observations reveal that saffron extract can ameliorate the impairment of learning and memory as well as the disturbances in oxidative stress parameters in the hippocampus of experimental models of MS.

Quality of life in phenylketonuria (PKU) patients residing in Iehran, Islamic republic of Iran

Background: The current study tried to evaluate the quality of life (QOL) of phenylketonuria (PKU) patients residing in Tehran, Iran and it also tried to determine the average quality of life of patients. Various aspects of QOL have been analyzed depending on gender, age, and educational levels of the subjects. Methods: The sample of the study consisted of late-diagnosed PKU patients who were referred to Mofid Children's Medical Center as well as to Ali-Asghar Hospitals in order to receive metabolic diets on a one year period starting from spring 2013 to spring 2014. Due to the limited study population, subjects were selected via census, therefore 82 patients were enrolled. The research material consisted of the Persian edition of World Health Organization Quality of Life questionnaire (WHOQOL-BREF), designed to examine physical, mental, social and environmental health. The data was gathered on two levels-descriptive and inferential- by using the SPSS software, V.20. Results: Results indicated that the low quality of life in the late-diagnosed patients suffering from PKU, with mental, physical, social, and environmental aspects, was below the average. Still, even if it was not gender dependent, QOL was greatly influenced by the educational level of the patients. Moreover, it was discovered that the mental health of the patients above 40 years old was significantly lower than the other age groups. Conclusions: According to the findings of this study, it was recommended that special attention should be given to the improvement of the social and mental health of PKU patients.

Tumors of the Central Nervous System: An 18-Year Retrospective Review in a Tertiary Pediatric Referral Center

OBJECTIVE

Few studies exist on the demographics and trends of pediatric central nervous system (CNS) tumors in Iran. In this study, we retrospectively reviewed all cases with confirmed CNS tumors admitted to Mofid Pediatric Hospital, Tehran, Iran during the last 18 years.

MATERIALS & METHODS

Data on gender, age of diagnosis, pathologic classification and tumor location were extracted from the available medical records. We used the last version of International Classification of Childhood Cancer.

RESULT

Overall, 258 (81.9%) brain tumors and 57 (18.1%) spinal tumors were identified. Our subjects comprised of 147 (46.7%) female and 168 (53.3%) male children. More male dominancy was observed in brain tumors with a male to female ratio of 1.2 compared with 1.03 of spinal tumors. Malignant CNS tumors were most common in 1-4 yr age group. The four most common brain tumors in our subjects were astrocytomas, medulloblastoma, ependymoma and craniopharyngioma. Overall, 53.1% of the brain tumors were supratentorial. Gliomas, PNET and neuroblastma were the most frequent primary spinal tumors in our study. We observed an increasing trend for both brain and spinal tumors that was moreremarkable in the last 5 years.

CONCLUSION

Our results are comparable with similar single center studies on CNS tumors during childhood. The observed disparities could be attributed to the single center nature of our study and geographical, environmental and racial variations in pediatric CNS tumors. The increasing trend of both brain and spinal tumors could warrant further investigations at provincial and national levels to investigate probable contributing environmental risk factors.

Monotheistic and spiritual style literature in traditional medicine's resources

The basis for success of Iranian Gnostics, poets and scientists were moral teaching, attention to origin and searching for specific goals in creation of human and creatures as well as finding some of his essence in studying all phenomena regarding the creation of universe by divine attitude. There is no surprise that such relationship was bilateral and according to his promise to those who truly follow him such that he will show the right path of learning to human in order to obtain the secrets of life. This relationship has resulted in growth of famous Iranian scientists such as Rhazes, Ahvazi, Avicenna, Ferdousi and… at the beginning of the second millennium. Thus, goal of this research is to study the style of writing in original resources of traditional medicine. In order to increase the accuracy of this study, an electronic database version of traditional medicine resources has been prepared. Writing style of Alhavi book (by Rhazes), Kamel-al-Sanaah (by Ahvazi), Canon of Medicine (by Avicenna) and Zakhireye Khwarazmshahi (by Jorjani) was considered. This task was accomplished by searching using related key words such as God, creator, magnificent, omnipotent, transcendent, omniscient and many other similar words and then encoding them. Finally, content analysis of these words was performed. Hundreds of monotheistic words and many small and great texts related to monotheistic literature have been encountered in the literature, and some are mentioned in the following. Rhazes has started some parts of Alhavi by remembering the name of merciful God and saluting his prophets and has mentioned "God" for more than 570 times and the word "God willing" for more than 215 times. Ahvazi has written his book called Kamel-al-Sanaah by using monotheistic literature, so that both volumes of book are started by remembering the name of God and saluting his prophets. In the introduction of first volume of his book, he has acknowledged God due to conferring logic and wisdom to human and has used the word "God" more than 230 times in his book. He has also referred to a famous testimony of Hippocrates and added some more issues in relation to medical ethics. Avicenna has started the Canon of Medicine in five volumes by remembering God and saluting his prophets. When referring to points related to having specific goal in structure of body organs, he immediately has praised God. Jorjani also has followed up the same attitude of three mentioned writers. We have found out that any of the Iranian poets, Gnostics and scientists who have studied nature have reached to the same conclusion from their own point of view, meaning, they all have observed permanent emergence of God in all phenomena of universe. Poets considered the beauties of nature, Gnostics studied mental issues and scientists of natural sciences explored the physiology and anatomy of human body; however, all of them referred to beauty, magnificent, discipline and having goal in creation of universe and all of its phenomena in their books. They have written their valuable books by benefiting monotheistic literature and have published their research results by inference of seeking God and paved the way for next generations. They experienced the usefulness of cumulative effects of spirituality, religion and health on performance and thereby emphasizing the need to incorporate spirituality and religion in teachings curriculums.

Evaluation of rubella IgG antibodies among women at marriage in kermanshah city, before and after mass vaccination

BACKGROUND

Rubella is a mild viral infectious disease, usually occurs subclinically without a serious complication. But if occurs during pregnancy, specially the first trimester, it can transmit and invade to fetus causing congenital rubella syndrome or fetal death. In 2003, nearly all Iranians at the age of 5 to 25 years old were vaccinated against rubella and the vaccine was included in the compulsory immunization, MMR afterwards.

METHODS

This study was carried out on girls attended at a marriage consultancy center in Kermanshah city (West of Iran) in 2006. Considering 95% of confidence, the sample size was estimated at 140. All samples were tested using ELISA serologic method and compared with similar study conducted on 240 unvaccinated girls at the same place in 1999.

RESULTS

Antibody positivity was observed in 99.3%, compared to 79.58% of the previous study. A rise of 19.72% (95% CI 12.7%-26.7%) of seropositivity was observed in vaccinated girls versus unvaccinated ones (P < 0.001).

CONCLUSION

In our previous study, we had recommended to screen for susceptibility to rubella before marriage, which is no longer required since more than 99% of vaccinated girls showed immunity at the time of marriage. However, as sustainability of immunity after rubella vaccination is usually less than immunity due to illness, we recommend screening for rubella protective antibody every few years.

The socio-political situation of Avicenna's time and his spiritual messages: on the occasion of 1031 st birth anniversary of Avicenna (23 August 980)

In the fourth century A.H. (tenth century AD) many thinkers, philosophers, jurisprudents, poets, and authors were present in different scientific, literary and health fields in ancient Iran and Islamic world that by their hard attempts the sciences and literature were safe from incidents and resulted in growth, development and innovation of Islamic sciences. Meanwhile, Avicenna was superior to all others and the most famous scientist. He was a great human that by attempting hard, perseverance, stability, patience, and believing in God could complete supreme scientific ranks and compiled encyclopedia of Canon of Medicine and besides gathering many written important issues that most of them were confiscated at libraries of kings. He added medical experiences of ancient Iran and especially Jondishapour University and also his personal experiences and finally Canon of Medicine by benefiting from monotheistic style and science based on faith was written. He has written a book that is regarded as root and basics of modern medicine and by completing it some infrastructure health viewpoints and common medicine were created. It is a kind of book that in spite of scientific advances and production of modern research tools many of its contents are replaced with modern methods of medicine and health, but still many of its health basic messages, research orientation and monotheism with great dynamic mode is considerable at world's medical references. The aim of this study is evaluate the political situation of Avicenna's time and a review of his Godly writings. This is a library study by using electronic version of Canon of Medicine and other related resources. Findings, include writing style of monotheistic literature, and freeing from nihilism and affiliating diseases to Satan, jinn and such issues. It is necessary that our students within course of Iranian and Islamic culture and civilization to be more familiar with monotheistic thoughts and activities of scientists like Avicenna.

The religious and social principles of patients' rights in holy books (Avesta, Torah, Bible, and Quran) and in traditional medicine

Health protection and promotion in healthy people and restoring patients' health have been the most important themes in medicine and health throughout our history. Therefore, discussion of different aspects of patients' rights includes implementation of these objectives by the medical community, including physicians, nurses, pharmacists, etc., and the people in charge of health affairs. The principal objective of our research is the study of medical ideology and the approaches of our ancestors in relation to different aspects of patients' rights. To study the different ideologies of traditional medicine in relation to patients' rights, appropriate data were extracted from the original resources of traditional medicine and from religious books. By means of library research we studied these resources in addition to electronic versions of the Alhavi book (by Rhazes), the Kamel-al-Sanaah (by Ahvazi), the Canon of Medicine (by Avicenna), the Zakhireye Khawrazmshahi (by Jorjani), the Avesta, the Torah, the Bible, the Quran, and many other resources, and, finally, after searching, gathering, and encoding the findings, analyzed them qualitatively for thematic content. The holy Avesta book clearly insists on the competence of physicians and setting the appointment fee in accordance with peoples' income. The Old Testament (holy Torah) warned government officials who did not observe patients' rights. In the four gospels (holy Bible) the importance of treatment and taking care of the patient is stressed. After the emergence of Islam, medical students, before beginning the principal courses, had to study Islamic jurisprudence, ethics, logic sciences, natural sciences, geometry, astrology, calculus, and similar courses so that after purifying their soul they could enter the saintly profession of physicians. The holy Quran refers to saving the life of a human irrespective of social class, race, and religion, and insists on exemption of patients from physical activity, including the physical aspects of prayer. In these resources, some warnings are offered in relation to fake drugs, the lack of awareness of some physicians, the need for complete preparedness of medical society, and the need to manufacture appropriate drugs and offer a suitable medical service. This information is to familiarize medical and health authorities and persons receiving health services. According to the evidence available about traditional medicine, there was no specific difference between public and professional ethics, public and professional rights, or rights and ethics-ethics were no different from rights nor rights from ethics. So ethics are similar to the soul in the body of rights, and rights are similar to the litter of ethics, and they have developed in parallel with each other. Traditional medicine is community-based and preservation of the health of healthy people is given priority over the treatment of patients; there is insistence that "health rights" has wider scope than "patients' rights". It can be stated that health rights in Iran both before and after the emergence of Islam have been based on guidance from divine religions, observation of humanist ethics, passing suitable courses in the basic sciences, and an introduction to the practical piety of our ancestors, in addition to the syllabus of medical and health education.

Intra-familial Transmission of Hepatitis B virus Infection in Zahedan

BACKGROUND

The household transmission of hepatitis B virus (HBV) is a major health problem. The prevalence rate of this infection is reported about 11% to 57% among family members of HBsAg carriers.

OBJECTIVES

This study was conducted to evaluate serological determinants of chronic hepatitis B infection, especially HBsAg positivity, among family members of asymptomatic HBsAg positive carriers in Zahedan (Southeast of Iran).

PATIENTS AND METHODS

In a cross-sectional study, data were collected from the total number of 454 HBsAg positive cases and 1817 members of their family by trained interviewers and a validated questionnaire. In addition, blood samples were obtained and titrated to detect serologic markers of hepatitis B. All subjects were recruited following informed consent to the study.

RESULTS

In total, 454 chronic HBsAg carriers (66% male) with mean age of 36 ± 10 years and 1817 of their family members were included in the study. The prevalence rate of HBsAg and HBcAb positivity among household members were 19.3% (n = 351) and 51% (n = 573), respectively. The frequency of HBV markers was different by age groups. The highest prevalence rate of HBsAg (34.9%) and HBcAb (31.9%) positivity were found in the age group of 21-30 years old. Importantly, the mothers of index cases had the highest prevalence of HBsAg positivity compared to their spouses who had the lowest proportion (53.2% vs. 8.4%, P < 0.001).

CONCLUSIONS

In family members, HBsAg positivity was four times greater than the general indigenous population. Considering the importance of close contacts for transmission, it was more prevalent in mothers of index cases compared to their spouses, suggesting more efficient mother-to-child than sexually transmission of HBV. It was also more prevalent in those having a history of hepatitis B in their maternal family compared to those with paternal one, probably due to more efficient transmission from infected mothers to children. The lower prevalence of HBsAg positivity in lower age groups could be attributed to vaccination of Iranian infants since 1993 and the screening of HBsAg positive mothers during the last two decades.

Counseling and Harm Reduction Centers for Vulnerable Women to HIV/AIDS in Iran

BACKGROUND

Human immunodeficiency virus (HIV) is a public health challenge facing both developing and developed nations. Although injecting drug use is even the main route of HIV transmission in Iran, sexual route is rising gradually. Vulnerable women have been considered as important bridging population for driving HIV epidemics. To increase the access to vulnerable women, in 2007, 5 pilot centers were established in risky areas to deliver comprehensive services to women who themselves or their spouses are engaged in drug use, risky sexual behavior or have history of imprisonment. Management of Sexually Transmitted Infection, psychological counseling and harm reduction are provided by female staff. The aim of this study was to report the activities conducting in 2008.

METHODS

Registered information was used to assess the demographic characteristic, HIV/ AIDS related risk factors and services delivered to clients.

RESULTS

Till March 2008, 442 clients have been admitted. Most of them (36.2%) had 25-34 years old. 14.3% were illiterate and 31% were totally jobless. The most prevalent risk factors were risky sexual behavior (27.1%) and non-injecting drug use (23.2%). Injecting drug use was detected in 11.3% of attendees. Dividing clients according to marital status, risky sexual behavior was the main risk factor in unmarried (40.2%) and divorced (26.9%) but in married and widow ones, non-injecting drug use was the most (25.8% and 36.5% respectively). Harm reduction (40.5%) and counseling (36.6%) were the most delivered services.

CONCLUSION

Since vulnerable women play a critical role to spread HIV-epidemic to general population, increasing centers provide more access to this population.

The First Epidemic and New-emerging Human Fascioliasis in Kermanshah (Western Iran) and a Ten-year Follow Up, 1998-2008

BACKGROUND

Fascioliasis is one of the most common zoonotic diseases in Iran and other parts of the world. Although the largest epidemic of this disease has occurred in northern provinces of Iran (Guilan) during the past two decades and a few cases have also been reported in Tehran and the other provinces, there has been no evidence of its' occurrence in western provinces of Iran such as Kermanshah before the outbreak which is being reported.

METHODS

The study was conducted by teamwork of infectious disease specialist, parasitologist, general practitioner, entomologist, and laboratory technician. It is an "epidemic investigation" and a cross sectional descriptive one. Clinical data and para-clinical changes are recorded considering all of the population of a village in Kangavar, one of the suburbs of Kermanshah (western Iran).

RESULTS

The mean age was 21.65, (SD=12.44). Fifty three percent were female, and all of them were farmers. Eighty two percent had a history of watercress ingestion in a period of 1-2 months before the admission and 18% consumed other vegetables. The average of eosinophils was 32.35% (SD=26). The patients' Enzyme Linked Immunosorbent Assay (ELISA) and Counter Current Immuno-electrophoresis (CCIE) serological tests were reported positive by the department of parasitology, Pasteur Institute of Iran. Treatment response to triclabendazole was excellent. A ten-year clinical and laboratory follow-up revealed no evidence of abnormality in treated patients.

CONCLUSIONS

It was the first case of human fascioliasis in west Iran and was a real epidemic and an emerging infectious disease for this area at that time. The clinical symptoms were less severe compared with other reports. Health education to inhabitants and health care workers can lead to rapid detection of such outbreaks.

Improvement in health indicators of islamic republic of iran in the years 2004 and 2008

BACKGROUND

As a performance evaluating program, healthcare indicators of the Islamic Republic of Iran at the end year of the 4th five-year socioeconomic strategic plan (2008) were evaluated in comparison with the same indicators at the 1st year of the 9th government (2004).

METHODS

The indicators were selected with the Delphi technique among the published indicators in the two period of time in 41 universities and in the country. Data gathering was done on the current health information system and were statistically analyzed assessing their trends.

RESULTS

The provinces of Sistan and Baluchistan (3.4%), Kerman (2.84%), Hormozgan (2.83%), Tehran (2.63%) and Qom (2.07%) had the highest rate of population growth over these years. Improving access to primary health care (PHC) in rural areas in Iran was evident during these years. The average hospital bed index in 1998 was one bed per 1000 population in the country and it was 1.62 in 2008. This Index was the highest in the province of Yazd and lowest in Ilam during both periods.

CONCLUSION

A significant ascending trend was observed for indicators in all medical universities. A promotion in healthcare indicators in the lesser developed provinces seems necessary.

Epidemiological, clinical, and laboratory features of brucellar meningitis

BACKGROUND

One of the rare complications of brucellosis is mononuclear meningitis, which usually imitates systemic disease.

METHODS

Documents of patients with confirmed brucellar meningitis hospitalized in Sina Hospital (Western Iran) between 1988-2005 were collected.

RESULTS

The average age was 26.9. 64% were female and 36% were male. There were 25% confirmed cases in the spring, 21% in summer, 33% in autumn and 21% in winter.Patient complaints in order of frequency were: headache (95%), vomiting (77%), fatigue (39%), myalgia (15%), movement disorders (15%), arthralgia (13%), sleepiness (13%), and aphasia (3%). The main clinical findings were: nuchal rigidity (74%), splenomegaly (49%), fever (41%), Kernig's (41%), and Brudzinski's signs (39%). Leukopenia (WBC<4.5×109/L; 18%), leukocytosis (WBC>9.5×109/L; 20%), and anemia (hemoglobin level<13 g/dL in men and 12 g/dL in women) were detected in 16% of patients. The Wright agglutination test, with a titer of 1:80 to 1:1280 was present in the serum of all patients, CSF Wright test or Coombs test was positive in half of the patients. Blood, bone marrow and CSF cultures were positive in 6 out of 10 patients.

DISCUSSION

The epidemiological aspects of brucellar meningitis are similar to systemic brucellosis and, in most studies; there is no significant difference between them. The sex distribution of patients was different from most studies. Seasonal distribution of the disease did not follow seasonal distribution of systemic brucellosis, however, clinical findings or laboratory changes were similar to Turkey and other studies in Iran. A definite response, without complications and next recurrence, in this study, was achieved with co-trimoxasole plus rifampin for 45 days of therapy.

Two cases of gastrointestinal anthrax with an unusual presentation from Kermanshah (western Iran)

During 1988-1994 a total of 38 cases of human anthrax were admitted to Sina Hospital in Kermanshah (western Iran). There were two cases of gastrointestinal anthrax (5.3%) with culture positive ascitic fluid. Among the many reported gastrointestinal signs and symptoms, unexpectedly one of our patients had only vomiting and ascites whereas the other case had only ascites. Neither had abdominal pain, tenderness, diarrhea, hematemesis, melena, or other expected signs and symptoms of anthrax. Therefore, in contrast to the available reports, these cases presented atypically and despite receiving a sufficient dose of penicillin, the drug of choice at that time, both patients died. Gastrointestinal anthrax is not as rare as reported but due to an unusual presentation it may be misdiagnosed. Paying attention to gastrointestinal anthrax in the differential diagnosis of ascites with unknown origin and other gastrointestinal presentations in endemic areas may help to diagnose more cases of anthrax. Timely appropriate management in an early stage of the disease, may increase their chances of survival.

Risk assessment of lung cancer and asbestosis in workers exposed to asbestos fibers in brake shoe factory in Iran

Chrysotile asbestos fiber, imported from Russia, is used mainly for manufacturing purposes in Iran and related risks in the form of asbestosis and cancer were studied. Occupational exposure of all male workers (61 persons) to asbestos in a brake shoe factory was monitored. Cumulative exposures were determined through multiplication of typical exposure and work history. Risk assessment of exposed workers was estimated by risk criteria recommended by the American Environmental Protection Agency. Measurement of lung function parameters such as forced expiratory volume in one second (FEV(1)), forced volume capacity (FVC) and FEV(1)/FVC of exposed workers were obtained. Unadjusted correlation and adjusted correlation analysis for support of the association between cumulative exposure (fiber/ml-yr) and lung function parameters were used. Exposure of majority of exposed group was far greater than the occupational exposure limits (0.1 fiber/ml) in the range of 0.06-8.06 fiber/ml. Cumulative exposures in the range of 0.02 to 110.77 fiber/ml-yr were obtained. According to the risk criteria stated by ATSDR, risk assessment of workers in term of fibrotic changes was predicted for at least 24.6 percent of the exposed subjects. Again, according to the lung cancer risk criteria stated by EPA, 59 percent of workers will have excess risk. Negative correlation between lung function parameters (FEV(1), FEV(1)/FVC) and cumulative exposures adjusted for age and BMI were significant (p<0.05).