Metabolic Syndrome and Assisted Reproductive Techniques

Objective

Metabolic syndrome is a risk factor affecting reproductive health and pregnant outcomes. So far, the effect of this syndrome on the success rate of assisted reproduction techniques (ART) has not been investigated. The aim of this study was to investigate the relationship between metabolic syndrome and the success rate of ART in infertile women in Isfahan.

Materials and methods

A prospective cohort study performed on 147 women candidates using in-vitro fertilization/intra cytoplasmic sperm injection (IVF/ICSI) and/or ICSI methods referred to Isfahan Infertility Center in two groups with metabolic syndrome(n=49) without metabolic syndrome(n=98), by convenience sampling methods in Isfahan, Iran in 2018. Body mass index (BMI) and waist, abdominal circumference, Serum triglyceride (TG), cholesterol and FBS were measured. If βHCG test was positive (day 15-16 after ART), transvaginal sonography (TVS) was done 15 days later. Pregnant women were followed up to the 20th week of pregnancy. To analyze, t-test, chi-square and logistic regression tests were used.

Results

The frequency of metabolic syndrome was 33.4% (n=49). The frequency of ART was not significantly different between women with and without metabolic syndrome (p=0.321). The relative frequency of pregnancy (p=0.907) and abortion (p=0.896) did not show a significant difference between the two groups. Independent t-test showed that the mean FBS, HDL, TG, systolic and diastolic BP, abdominal circumference and BMI in the studied units did not differ significantly based on the occurrence of pregnancy and abortion.

Conclusion

According to the results of this study, there was no significant difference between the indicators of metabolic syndrome and the success rate of ART in achieving, pregnancy and pregnant outcomes in the first twenty weeks of pregnancy.

Semi-automated digital workflow to design and evaluate patient-specific mandibular reconstruction implants

The reconstruction of large mandibular defects with optimal aesthetic and functional outcomes remains a major challenge for maxillofacial surgeons. The aim of this study was to design patient-specific mandibular reconstruction implants through a semi-automated digital workflow and to assess the effects of topology optimization on the biomechanical performance of the designed implants. By using the proposed workflow, a fully porous implant (LA-implant) and a topology-optimized implant (TO-implant) both made of Ti-6Al-4V ELI were designed and additively manufactured using selective laser melting. The mechanical performance of the implants was predicted by performing finite element analysis (FEA) and was experimentally assessed by conducting quasi-static and cyclic biomechanical tests. Digital image correlation (DIC) was used to validate the FE model by comparing the principal strains predicted by the FEM model with the measured distribution of the same type of strain. The numerical predictions were in good agreement with the DIC measurements and the predicted locations of specimen failure matched the actual ones. No statistically significant differences (p < 0.05) in the mean stiffness, mean ultimate load, or mean ultimate displacement were detected between the LA- and TO-implant groups. No implant failures were observed during quasi-static or cyclic testing under masticatory loads that were substantially higher (>1000 N) than the average maximum biting force of healthy individuals. Given its relatively lower weight (16.5%), higher porosity (17.4%), and much shorter design time (633.3%), the LA-implant is preferred for clinical application. This study clearly demonstrates the capability of the proposed workflow to develop patient-specific implants with high precision and superior mechanical performance, which will greatly facilitate cost- and time-effective pre-surgical planning and is expected to improve the surgical outcome.

Toward Antibacterial Coatings for Personalized Implants

The complex reconstructive surgeries for which patient-specific orthopedic, maxillofacial, or dental implants are used often necessitate wounds that are open for a considerable amount of time. Unsurprisingly, this allows bacteria to establish implant-associated infection, despite the scrupulous sterilization efforts made during surgery. Here, we developed a prophylactic bactericidal coating via electrophoretic deposition technology for two 3D-printed porous titanium implant designs. The surface characteristics, antibiotic release behavior, antibacterial properties, and impact on osteoblast cell proliferation of the optimized coatings were investigated. The results unequivocally confirmed the biofunctionality of the implants in vitro. This study reveals a new avenue for future antibacterial patient-specific implants.

Adherence to Dietary Approaches to Stop Hypertension (DASH)-Style Diet and the Risk of Cancer: A Systematic Review and Meta-Analysis of Cohort Studies

Objective: Several investigators have proposed a protective association between dietary approaches to stop hypertension (DASH) style diet and risk of cancers; however, they have had inconsistent results. The present study aimed to systematically review the prospective cohort studies and if possible quantify the overall effect using meta-analysis. Methods: PubMed, Scopus, and Google Scholar were searched for cohort studies published up to July 2018. Relative risks (RRs) that were reported for fully adjusted models and their confidence intervals were extracted for meta-analysis. The random effects model was used to combine the RRs. Results: Seventeen studies were eligible to be included in the systematic review, from which nine reports assessed the association between the DASH diet and risk of mortality from all cancer types, four assessed incidence of colorectal cancer, and two studies assessed the risk of colon and rectal cancer separately. Four studies examined the association with the incidence of other cancers (breast, hepatic, endometrial, and lung cancer). Meta-analysis showed that high adherence to DASH is associated with a decreased mortality from all cancer types (RR = 0.84, 95% confidence interval [95%CI]: 0.81-0.86). Participants with the highest adherence to the DASH diet had a lower risk of developing colorectal (RR = 0.79, 95%CI: 0.75-0.83), colon (RR = 0.80, 95%CI: 0.74-0.87), and rectal (RR = 0.84, 95%CI: 0.74-0.96) cancers compared to those with the lowest adherence. Conclusion: DASH-style diet should be suggested as a healthy approach associated with decreased risk of cancer in the community. Prospective studies exploring the association for other cancer types and from regions other than the United States are highly recommended.

The Effect of Vitamin D Supplementation on Prostate Cancer: A Systematic Review and Meta-Analysis of Clinical Trials

Vitamin D has received attention for its potential to disrupt cancer processes. However, its effect in the treatment of prostate cancer is controversial. This study aimed to assess the effect of vitamin D supplementation on patients with prostate cancer. In the present study, PubMed, Scopus, ISI Web of Science, and Google Scholar were searched up to September 2017 for trials that evaluated the effect of vitamin D supplementation on prostate specific antigen (PSA) response, mortality, and its possible side effects in participants with prostate cancer. The DerSimonian and Laird inverse-weighted random-effects model was used to pool the effect estimates. Twenty-two studies (16 before-after and 6 randomized controlled trials) were found and included in the meta-analysis. The analysis of controlled clinical trials revealed that PSA change from baseline [weighted mean difference (WMD)=-1.66 ng/ml, 95% CI: -0.69, 0.36, p=0.543)], PSA response proportion (RP=1.18, 95% CI: 0.97, 1.45, p=0.104) and mortality rate (risk ratio (RR)=1.05, 95% CI: 0.81-1.36; p=0.713) were not significantly different between vitamin D supplementation and placebo groups. Single arm trials revealed that vitamin D supplementation had a modest effect on PSA response proportion: 19% of those enrolled had at least a 50% reduction in PSA by the end of treatment (95% CI: 7% to 31%; p=0.002). Although before-after studies showed that vitamin D increases the PSA response proportion, it does not seem that patients with prostate cancer benefit from high dose vitamin D supplementation and it should not be recommended for the treatment.

Effect of chloroquine on some clinical and biochemical parameters in non-response chronic hepatitis C virus infection patients: pilot clinical trial

BACKGROUND

Hepatitis C virus infection frequently leads to chronic hepatitis C which may progress to cirrhosis and can be ended to hepatocellular carcinoma. This study aimed to investigate the effect of Anthropometric Parameters, Vit D3, Thyroid Function, Ferritin and Biochemistry Parameters in patients chronically infected with HCV with non-response criteria which was treated by chloroquine.

METHODS

This study was the continuation of our previous investigation with a triple-blind method in a randomized controlled pilot study. After understanding the study procedures, patients signed an informed consent form and were randomized into the treatment (chloroquine 150 mg once daily, for 8 weeks) and control (placebo once daily, for 8 weeks) groups. The inclusion criteria were male, between 18 and 60 years of age, confirmed chronic hepatitis C with non-response criteria, and Genotype 1.  Data were analyzed with an intention to treat perspective at the end follow up (12 weeks) considering to variables such as anthropometric parameters, Vit D3, thyroid function, ferritin and biochemistry parameters evaluated.

RESULTS

Although there were decreases in total weight (P-value=0.4), mid-arm circumference (P-value=0.05), and body mass index (P-value=0.04) there were increases in total body fat (P-value=0.8) and triceps skin fold thickness  (P-value=0.7) in the intervention group compared to the control group. Also, a reduction of AST (P-value=0.30), ALT (P-value=0.10), cholesterol (P-value=0.005), triglyceride (P-value=0.40) and ferritin (P-value=0.030) levels was seen in the intervention group during the follow up period. Our results also showed that serum TSH levels (P-value=0.5) were slightly higher in the chloroquine group than in the placebo group, though the trend was reversed for T3 (P-value=0.05) and T4 (P-value=0.04) levels. however, median of T3 and T4 were similar in both groups. A significant increase in vitamin D levels from 15 to 34 ng/ml was observed in the chloroquine group (P-value=0.04).

CONCLUSIONS

The results suggest that chloroquine therapy may be very useful for HCV treatment in patients with non-response criteria, and helps to normalize some anthropometric parameters, biochemical, ferritin, and vitamin D status.

Epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran: a community-based survey

OBJECTIVE

To determine the epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran.

METHODS

This cross-sectional study was conducted in Fars Province of Iran during a 29-month period from March 2009 to July 2011. The data were from the Fars Forensic Medicine Registry. In 4 923 recorded road traffic accident fatalities, 971 deaths were due to pedestrian accidents. The demographic and accident-related information were analyzed by SPSS version 11.5. P value less than 0.05 was considered significant.

RESULTS

The mean age of decedents was (47.2+/-26.2) years, ranging from 6 months to 103 years old. Males accounted for 69.8% of all deaths. Fatal accidents were most common in September; 56.1% of the fatal injuries occurred on intracity roads and 33.1% on extracity roads. Fatal head injuries were present in 60.54% of cases. Evaluation of the injury site and the cause of death found that they were significantly associated with age, interval between injury and death. Besides, the type of roads played an important role in mortality.

CONCLUSION

Although the clinical management of trauma patients has been improved in our country in the recent decade, decreasing the burden of injuries needs coordination among trauma system organizations.

Fatal motorcycle accidents in Fars Province, Iran: a community-based survey

OBJECTIVE

To identify the main characteristics of victims of motorcycle accidents in Fars Province, Iran.

METHODS

This cross-sectional study was conducted in Fars Province which has the fourth largest population of all 31 provinces in Iran from March 2009 to June 2010. We included data from all 542 recorded cases of fatalities due to motor vehicle accidents. Data were recorded from the forensic medicine registry consisting of demographic and accident-related information. Demographic information consisted of name, age, sex, status of fatal victim (motorcycle driver vs passenger) and educational level.

RESULTS

Of the 2 345 autopsy records from the forensic medicine archives, 542 (23.1%) gave the cause of death as motor vehicle accidents. Mean age of these victims was (31.4+/-6.5) years, and the male to female ratio was 28. Head injury was the most common cause of death in these victims, and overall they tended to have a low level of education. Motorcycle accidents frequently involved younger age groups (15-35 years), and head trauma related with non-use of a helmet was the most common cause of death.

CONCLUSIONS

Head injury is frequent among victims in the province we studied. This situation may be related to the victims' low socioeconomic status and little education regarding traffic laws leading to speeding and disregard of these laws along with their weak enforcement.

Depression and Obesity/Overweight Association in Elderly Women: a Community-Based Case-Control Study

Overweight/obesity and depression are common among women especially in the elderly and can lead to unfavorable outcomes. We aimed to determine the association of overweight with depression and also to find any correlation of depression with some anthropometric indices in old women. A total of 94 depressed elderly women were compared with 99 non-depressed controls. The structured diagnostic interview based on DSM-IV were performed to diagnose depression, and Geriatric Depression Scale (GDS) was completed to rate it. Anthropometric indices were measured and compared between groups. Pearson correlation coefficients were determined for linear relations between variables. Odds Ratio of obesity and overweight in depressed subjects comparing with normal participants was 1.45 (95%CI=0.63-3.32). A significant correlation was observed between BMI and GDS score (r=0.231, P-value=0.001). Total body fat (P-value=0.001) and BMI (P-value=0.016) were significantly higher in depressed women than non-depressed women. Despite the significantly higher total body fat and BMI among old women with depression, only a weak correlation was seen between BMI and GDS score.

The impact of depression and malnutrition on health-related quality of life among the elderly Iranians

INTRODUCTION

The present study aimed to assess the association between nutritional status and depressive symptoms among elderly Iranians and to explore their impact on their Health-Related Quality of Life (HRQoL).

METHODS

In this cross-sectional study, 447 elders aging from 55 to 85 years were randomly selected and completed the Iranian version of Geriatric Depression Scale-15 (GDS), Mini Nutritional Assessment (MNA), and the Iranian version of Short Form Health Survey (SF-36).

RESULTS

Out of the 447 elderly, 72.1% were female with the mean age of 65.99 ± 7.89 years. The prevalence of depression was 38.1%. In addition, the SF-36 sub-scores tended to be lower among the elders with depressive symptoms according to GDS. The Physical Functioning (PF), Bodily Pain (BP), Role Physical (RP), Role Emotional (RE), and Mental Health (MH) dimensions of the SF-36 were also statistically poorer in the elders with depression. The mean MNA score was 24.6 ± 2.7; 35.4% of the participants were malnourished or at risk of malnutrition and 64.6% were adequately nourished. The sub scores of SF-36 were significantly lower in the elders with impaired nutritional status.

CONCLUSIONS

Considering the importance of the association among psychological and nutritional problems and HRQoL in caring for and promoting the welfare of the elders, this study provided fundamental information and a basis for further evaluation of this issue in developing and undeveloped countries.

To assess the effects of nutritional intervention based on advocacy approach on malnutrition status among school-aged children in Shiraz

BACKGROUND

The present study was carried out to assess the effects of community nutrition intervention based on advocacy approach on malnutrition status among school-aged children in Shiraz, Iran.

MATERIALS AND METHODS

This case-control nutritional intervention has been done between 2008 and 2009 on 2897 primary and secondary school boys and girls (7-13 years old) based on advocacy approach in Shiraz, Iran. The project provided nutritious snacks in public schools over a 2-year period along with advocacy oriented actions in order to implement and promote nutritional intervention. For evaluation of effectiveness of the intervention growth monitoring indices of pre- and post-intervention were statistically compared.

RESULTS

The frequency of subjects with body mass index lower than 5% decreased significantly after intervention among girls (P = 0.02). However, there were no significant changes among boys or total population. The mean of all anthropometric indices changed significantly after intervention both among girls and boys as well as in total population. The pre- and post-test education assessment in both groups showed that the student's average knowledge score has been significantly increased from 12.5 ± 3.2 to 16.8 ± 4.3 (P < 0.0001).

CONCLUSION

This study demonstrates the potential success and scalability of school feeding programs in Iran. Community nutrition intervention based on the advocacy process model is effective on reducing the prevalence of underweight specifically among female school aged children.

Dependence of the geriatric depression on nutritional status and anthropometric indices in elderly population

OBJECTIVE

Malnutrition and depression are highly prevalent in the elderly and can lead to unfavorable outcomes. The aims of the current study were to determine the association between malnutrition and depression and also to find any correlation of depression with some anthropometric indices in free living elderly.

METHOD

In this cross-sectional study, 337 elderly subjects (193 females) were selected using cluster sampling. Depressive symptoms and nutritional status were determined by the Geriatric Depression Scale (GDS) and the Mini-Nutritional Assessment (MNA) scores questionnaires, respectively. Anthropometric indices were measured all in standard situations. Chi squared test and t-test were used when necessary. Pearson correlation coefficients were calculated for linear relations between variables.

RESULTS

Of all the total subjects, 43.62% were depressed; and of whom, 48.01% were malnourished or at risk of malnutrition. GDS had a significant negative dependence with the MNA for the entire sample (r=-0.58, p <0.0001). However, there was no significant correlation between age and GDS or MNA scores. Moreover, the mean GDS scores differed significantly between men and women (p <0.05), and women were more depressed than men (27.9% vs. 15%, respectively). The elderly subjects living in urban areas were more depressed than those living in rural areas (39.46% vs. 3.85% respectively).

CONCLUSION

The results of the present study revealed a high prevalence of depression and malnutrition among old subjects. Moreover, depression was associated with worsening of nutritional status. The mechanism of this association needs further study.

Report on First Iranian International Conference on Women’s Health Held June 14-15, 2012 in Shiraz, Iran

Women’s health is increasing identified as a global health priority. Women’s health is affected by many factors, such as the economy, environment, society, culture, religion, and biology. For this reason, the Health Policy Research Center, Shiraz, Iran decided to hold The First Iranian International Conference on Women’s Health. The aim of this conference was to provide up-to-date information on different aspects of women’s health, including healthy aging, non-communicable and communicable diseases, psycho-social aspects, health promotion, reproductive health, and nutrition. Finally, the attending specialists and experts provided recommendations to be put into practice which reinforced the recommendations for additional clinical preventive services for women, mobilizing health professionals within practice, education, and research to address the national health goals, encouraging the adoption of ongoing evidence-based prevention guidelines, gender-sensitive, and culturally appropriate, persuading all stakeholders to harmonize their endeavors on women’s health, changing the viewpoint to the women as a workforce alliance as with like men, along with considering the major role of women as the basis of the family, and improving the coverage, accessibility, and quality of women-oriented health services.

Prevalence of metabolic syndrome in pre- and postmenopausal Iranian women

BACKGROUND AND AIMS

The metabolic syndrome (MetS) is a constellation of risk factors increasing the risk of developing cardiovascular disease and diabetes. Little information is available on the association between MetS and menopausal status in Iranian women. Therefore, the purpose of the current study was to examine the prevalence and severity of MetS in pre- and postmenopausal women based on two commonly employed assessment criteria.

METHODS

A total of 490 premenopausal and 434 postmenopausal women from the Shiraz Women's Health Cohort Study were included in the study. MetS was defined according to the criteria of the National Cholesterol Education Program-Adult Panel Treatment III (NCEP-ATPIII) and the International Diabetes Federation (IDF). Clinical, biochemical and anthropometric measures were collected from all study participants for determination of MetS.

RESULTS

The majority of participants had at least two components of MetS. Postmenopausal women, compared to premenopausal women, had a higher prevalence of MetS. The prevalences of MetS were 60.2% and 59.4% based on the NCEP-ATPIII and IDF definitions, respectively. Waist circumference, waist-to-hip ratio, blood pressure, and levels of fasting plasma glucose, total cholesterol, low density lipoprotein cholesterol, and triglycerides were higher in postmenopausal women compared to premenopausal women.

CONCLUSIONS

MetS is a major threat to women's health and an aging population, and longitudinal studies to determine the mechanism of postmenopausal MetS are required.

Epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran: a community-based survey

OBJECTIVE

To determine the epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran.

METHODS

This cross-sectional study was conducted in Fars Province of Iran during a 29-month period from March 2009 to July 2011. The data were from the Fars Forensic Medicine Registry. In 4 923 recorded road traffic accident fatalities, 971 deaths were due to pedestrian accidents. The demographic and accident-related information were analyzed by SPSS version 11.5. P value less than 0.05 was considered significant.

RESULTS

The mean age of decedents was (47.2+/-26.2) years, ranging from 6 months to 103 years old. Males accounted for 69.8% of all deaths. Fatal accidents were most common in September; 56.1% of the fatal injuries occurred on intracity roads and 33.1% on extracity roads. Fatal head injuries were present in 60.54% of cases. Evaluation of the injury site and the cause of death found that they were significantly associated with age, interval between injury and death. Besides, the type of roads played an important role in mortality.

CONCLUSION

Although the clinical management of trauma patients has been improved in our country in the recent decade, decreasing the burden of injuries needs coordination among trauma system organizations.

Fatal motorcycle accidents in Fars Province, Iran: a community-based survey

OBJECTIVE

To identify the main characteristics of victims of motorcycle accidents in Fars Province, Iran.

METHODS

This cross-sectional study was conducted in Fars Province which has the fourth largest population of all 31 provinces in Iran from March 2009 to June 2010. We included data from all 542 recorded cases of fatalities due to motor vehicle accidents. Data were recorded from the forensic medicine registry consisting of demographic and accident-related information. Demographic information consisted of name, age, sex, status of fatal victim (motorcycle driver vs passenger) and educational level.

RESULTS

Of the 2 345 autopsy records from the forensic medicine archives, 542 (23.1%) gave the cause of death as motor vehicle accidents. Mean age of these victims was (31.4+/-6.5) years, and the male to female ratio was 28. Head injury was the most common cause of death in these victims, and overall they tended to have a low level of education. Motorcycle accidents frequently involved younger age groups (15-35 years), and head trauma related with non-use of a helmet was the most common cause of death.

CONCLUSIONS

Head injury is frequent among victims in the province we studied. This situation may be related to the victims' low socioeconomic status and little education regarding traffic laws leading to speeding and disregard of these laws along with their weak enforcement.