Vol 45 No 4 (2016)

Review Article(s)

  • XML | PDF | downloads: 107 | views: 388 | pages: 409-422

    Background: Urogenital mycoplasmas are potentially pathogenic species causing genitourinary tract infections that may be initially asymptomatic but can progress and lead to severe complications and threaten reproductive health. However, the overall prevalence rate of this bacterium and its probable impacts on fertility potential have yet to be determined.

    Methods: We searched both English and Persian electronic databases using key words such as "Mycoplasma," "Ureaplasma," "M. hominis," "M. genitalium," "U. urealyticum," "U. parvum," "prevalence," and "Iran". Finally, after some exclusion, 29 studies from different regions of Iran were included in our study, and a meta-analysis was performed on collected data.

    Results: Urogenital mycoplasmas prevalence for women and men was high and ranged from 2%–40.5% and 2%–44.3%, respectively. The pooled prevalence in the male population was 11.1% (95% CI, 7.4%–16.4%) and in female was 12.8% (95% CI, 9.8%–16.5%). The prevalence of these bacteria was significantly higher in infertile men compared with that in fertile men. A high level of heterogeneity was observed for both men (I2 = 92.4%; P<0.001) and women (I2 = 93.3%; P<0.001). Some evidence for publication bias was observed in both men [Egger’s test (two-tailed P=0.0007), and Begg’s test (two-tailed P=0.0151)] and women [Egger’s test (two-tailed P=0.0006), and Begg’s test (two-tailed P=0.0086)] analysis.

    Conclusion: Since urogenital mycoplasmas may play a role in male infertility, screening strategies, particularly for asymptomatic individuals, and treatment of infected ones, which can reduce consequent complications, looks to be necessary.


Original Article(s)

  • XML | PDF | downloads: 106 | views: 370 | pages: 423-434

    Background: The healthcare and socio-economic burden resulting from influenza A (H1N1) pdm09 in Spain was considerable. Our aim was to estimate and compare the management (resource utilization) and economic healthcare impact in an at-risk group of unvaccinated pregnant women with an unvaccinated group of non-pregnant woman of childbearing age (15-44 yr old).

    Methods: We addressed this question with a longitudinal, observational, multicentre study. Inputs were the requirements in managing both groups of women. Outcome measures were healthcare costs. Direct healthcare (including medical utilisation, prescriptions of antivirals, medication, diagnostic tests, and hospitalisation) costs and indirect (productivity loss) costs were considered. Unit of cost was attributed to the frequency of health service resources utilisation. The mean cost per patient was calculated in this group of women.

    Results: We found that the influenza clinical pattern was worse in non-pregnant women as they had a high medical risk of 20.4% versus 6.1% of pregnant women. Non-pregnant required more antipyretics and antibiotics, and needed more health service resource utilisation (338 medical visits in non-pregnant women vs. 42 in pregnant women). The total cost of non-pregnant women was higher (€4,689.4/non-pregnant and €2,945.07/pregnant).

    Conclusions: Cost per (H1N1) pdm09 was lower for pregnant women, probably due to more preventive measures adopted for their protection in Spain. The highest costs were incurred by hospitalisations/day and work absenteeism for non-pregnant than for pregnant women. These data will allow better future pandemic influenza planning.



  • XML | PDF | downloads: 114 | views: 348 | pages: 435-440

    Background: The diagnosis of pulmonary tuberculosis (PTB) is complicated and time-consuming currently. There was association of PTB with serum tumor markers. In this study we aimed to evaluate the predictive role of serum CA125, CA199 and CEA as diagnostic tools for PTB.

    Methods: This study was designed as a case-control study with 565 subjects who visited the Yijishan Hospital from Jun to Dec in 2014.This case-control study matched as for age and sex with 113 cases and 452 controls. Serum CA125, CA199 and CEA levels were detected by electrochemiluminescence instrument. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was performed to evaluate the diagnostic value on PTB.

    Results: Serum levels of CA125, CA199 and CEA in PTB patients were significantly higher than those in control group (P<0.001). There was no significantly different of three tumor markers between initial treatment group and retreatment group. The logistic regression analysis showed that CA125 was an impact factor to PTB. The ROC analysis revealed that AUC of CA125 was 0.966 (95%CI: 0.951-0.981), the sensitivity, specificity in serum and cut-off were 95.6%, 85.0% and 10.30 U/ml, respectively.

    Conclusion: The serum CA125 has potential good diagnostic performance for PTB.



  • XML | PDF | downloads: 99 | views: 295 | pages: 441-450

    Background: This study examined the association between incident pulmonary tuberculosis (TB) and social and behavioral characteristics in Almaty Oblast, Kazakhstan from 2012 to 2013.

    Methods: We used a matched case-control design to estimate the role of factors for acquiring pulmonary TB. Totally 324 individuals were recruited from Sep 2012 to Mar 2013. Participants included 110 TB index cases with newly detected pulmonary TB. Each case was matched with one household and one community control. A total of 107 household and 107 community controls were included to the study. Adjusted odds ratios measuring associations between TB and risk factors were calculated by using a conditional multiple logistic regression analysis.

     Results: TB cases were more likely to be younger, recent smokers and have diabetes, when compared to household controls. Between TB cases and community controls, TB was significantly associated with age, non-married family status, living in a rented home, recent smoker, and having diabetes. Comparing TB cases with community controls, we found that foreign birth was marginally associated with incident TB case status.

    Conclusion: Our findings confirm the role of modifiable risk factors for TB in Kazakhstan; highlighting the importance of developing interventions addressing social determinants and proximate risk factors for high TB burden regions.



  • XML | PDF | downloads: 136 | views: 708 | pages: 451-459

    Background: Given that validity is the baseline of psychological assessments, there is a need to provide evidence-based data for construct validity of such scales to advance the clinicians for evaluating psychiatric morbidity in psychiatric and psychosomatic setting.

    Methods: This comparative cross-sectional study aimed to investigate the construct validity of the Malaysian version of the GHQ-28 and the SCL-90-R. The sample comprised 660 individuals including diabetics, drug dependents, and normal population. The research scales were administered to the participants. Convergent and discriminant validity of both scales were investigated by Confirmatory Factor Analysis (CFA) using AMOS. The Pearson correlation coefficient was utilized to obtain the relationship between the two scales.

    Results: The internal consistency of the GHQ-28 and SCL-90-R were highly acceptable, and confirmatory factor analysis confirmed the convergent validity of both scales. The results of this study revealed that the construct validity of GHQ-28 was acceptable, whereas discriminant validity of SCL-90-R was not adequate. According to Pearson correlation coefficient the relationships between three common subscales of the GHQ-28 and SCL-90-R were significantly positive; somatization (r=0.671, P<0.01), Anxiety (r=0.728, P<0.01), and Depression (r=0.660, P <0.01).

    Conclusions: This study replicated the construct of the Malaysian version of GHQ-28, yet failed to support the nine-factor structure of the SCL-90-R. Therefore, multidimensionality of the SCL-90-R as clinical purposes is questionable, and it may be a better unitary measure for assessing and screening mental disorders. Further research need to be carried out to prove this finding.


  • XML | PDF | downloads: 105 | views: 333 | pages: 460-468

    Background: Obesity associated with type 2 diabetes, and hypertension increased mortality and morbidity. Glutamate decarboxylase 2 (GAD2) gene is associated with obesity and it regulate food intake and insulin level. We investigated the association of GAD-2gene −243A>G (rs2236418) and +61450C>A (rs992990) polymorphisms with obesity and related phenotypes.

    Methods: Insulin, glucose and lipid levels were estimated using standard protocols. All subjects were genotyped (PCR-RFLP) method.

    Results: The −243A>G polymorphism of the GAD-2 gene was significantly associated with higher risk of obesity (P<0.05).

    Conclusion: GAD-2 gene polymorphisms influence obesity and related phenotype in complex manner, probably by regulating the food intake, insulin and body weight.



  • XML | PDF | downloads: 74 | views: 284 | pages: 469-473

    Background: Our aim was to investigate the effects of clinical application of perioperative predictive nursing on reducing psychiatric complications in Intensive Care Unit (ICU) patients after neurosurgery.

    Methods: A total of 129 patients who underwent neurosurgery and received intensive care were enrolled in our study from February 2013 to February 2014. These patients were divided into two groups: the experimental group (n=68) receiving predictive nursing before and after operation, and the control group (n=61) with general nursing. Clinical data including length of ICU stay, duration of the patients’ psychiatric symptoms, form and incidence of adverse events, and patient satisfaction ratings were recorded, and their differences between the two groups were analyzed.

    Results: The duration of psychiatric symptoms and the length of ICU stay for patients in the experimental group were significantly shorter than those in the control group (P<0.05). The incidence of adverse events and psychiatric symptoms, such as sensory and intuition disturbance, thought disturbance, emotional disorder, and consciousness disorder, in the experimental group was significantly lower than that in the control group (P<0.05). Patient satisfaction ratings were significantly higher in the experimental group than those in the control group (P<0.05).

    Conclusion: Application of predictive nursing on ICU patients who undergo neurosurgery could effectively reduce the incidence of psychiatric symptoms as well as other adverse events. Our study provided clinical evidences to encourage predictive nursing in routine settings for patients in critical conditions.



  • XML | PDF | downloads: 246 | views: 325 | pages: 474-484

    Background: The purpose of this study was to determine the relationship of demographic, psychological, social and environmental factors with physical activity and to determine whether indicators of physical activity differ by gender among Macedonian adolescents from Albanian ethnic community from 11 to 14 yr (N = 886).

    Methods: Research were conducted in 2014 in several primary schools randomly selected from Tetovo and Gostivar region of the R. Macedonia. Students completed a questionnaire which examined their level of participation in physical activity and sedentary behavior along with a number of potential correlates. Hierarchical regression was used to explore the relationship between hypothesised factors and physical activity.

    Results: The boys unlike the girls showed significantly higher levels of physical activity (P=0.001). Respondents of both genders who perceive greater benefits from the physical activity (P=0.010). They have more confidence in their abilities (P=0.001), enjoy more in the physical activities (P=0.016), perceive greater social support from friends (P=0.008) and parents (P=0.001) and have higher levels of physical activity.

    Conclusions: The results indicate the importance of developing a national plan and program to promote physical activity in order to help young people to change unhealthy lifestyle habits and increase the physical activity, thus improving their health.



  • XML | PDF | downloads: 118 | views: 419 | pages: 485-493

    Background: The aim of this study was to investigate the antibiotic susceptibility pattern as well as the phenotypic and genotypic biofilm formation ability of Staphylococcus aureus isolates from patients with urinary tract infection (UTI).

    Methods: A total of 39 isolates of S. aureus were collected from patients with UTI. The antibiotic susceptibility patterns of the isolates were determined by the Kirby-Bauer disk-diffusion. We used the Modified Congo red agar (MCRA) and Microtiter plate methods to assess the ability of biofilm formation. All isolates were examined for determination of biofilm related genes, icaA, fnbA, clfA and bap using PCR method.

    Results: Linezolid, quinupristin/dalfopristin and chloramphenicol were the most effective agents against S. aureus isolates. Overall, 69.2% of S. aureus isolates were biofilm producers. Resistance to four antibiotics such as nitrofurantoin (71.4% vs. 28.6%, P=0.001), tetracycline (57.7% vs. 42.3%, P=0.028), erythromycin and ciprofloxacin (56% vs. 44%, P=0.017) was higher among biofilm producers than non-biofilm producers. The icaA, fnbA and clfA genes were present in all S. aureus isolates. However, bap gene was not detected in any of the isolates.

    Conclusion: Our findings reinforce the role of biofilm formation in resistance to antimicrobial agents. Trimethoprim-sulfamethoxazole and doxycycline may be used as an effective treatment for UTI caused by biofilm producers S. aureus. Our results suggest that biofilm formation is not dependent to just icaA, fnbA, clfA and bap genes harbor in S. aureus strains.



  • XML | PDF | downloads: 168 | views: 481 | pages: 494-502

    Background: Nowadays, restriction on access and optimum use of resources is the main challenge of development in all organizations. Therefore, the aim of this study was to determine the technical efficiency and its factors, influencing hospitals of Tehran.

    Methods: This research was a descriptive-analytical and retrospective study conducted in 2014-2015. Fifty two hospitals with public, private, and social security ownership type were selected for this study. The required data was collected by a researcher-made check list in 3 sections of background data, inputs and outputs. The data was analyzed by DEAP 1.0.2, and STATA-13 technique.

    Results: Seventeen (31/48) of hospitals had the efficiency score of 1 as the highest technical efficiency. The highest average score of efficiency was related to social security hospitals as 84.32, and then the public and private hospitals with the average of 84.29 and 79.64 respectively. Tobit regression results showed that the size, type of practice, and ownership of hospitals were effective on the degree of their technical efficiency. However, there was no significant correlation between teaching / non-teaching hospitals with technical efficiency.

    Conclusion: Establishment of competition system among hospitals, constitution of medium size hospitals and allocation of budget to hospitals based on national accreditation system are recommended.



  • XML | PDF | downloads: 122 | views: 407 | pages: 503-514

    Background: Due to their specific nature, such as high incidence, high intensity and direct involvement of all members of society, traffic injuries are of particular importance. Through a mega data, this study investigated the epidemiological aspects and depict current situation of road traffic injuries in Iran.

    Methods: Using legal medicine and traffic police data, deaths from road traffic injuries in men were predicted through determining the most appropriate model for death using time series statistical models; and then most important human factors associated with it in a period of 6 yr in Iran was analyzed using multi-nominal regression model.

    Results: The frequency of deaths from traffic injuries in the last seven years was 172,834 cases and the number of deaths at the accident scene was 42798 cases, of which 24.24% (41,971 cases) were recorded by the Traffic Police experts. Death rate from traffic injuries has been declined from 38 cases per 100,000 people in 2004 to 31 cases per 100,000 people between 2009 and 2010. Fatigue and sleepiness (AOR=10.36, 95% CI: 8.41-13.3) was the most significant human risk factors for death outcome in the urban and suburban traffic injuries. According to the predictions, the death rate is about 16488 (CI 95%, 8531-24364) for the year 2012.

    Conclusion: Despite all measures to prevent such injuries, even fatal injuries have still a high incidence. Intervention in the human risk factors field would be more effective due to their important roles in traffic injuries in Iran.



Short Communication(s)

  • XML | PDF | downloads: 77 | views: 249 | pages: 515-522

    Background: One of Europe’s most well-developed industrial regions is found in the Republic of Bulgaria. The industrialization of the region has a big impact on air pollution. Thermal power plant “Maritza East” (the largest of its kind in southeastern Europe), the army training range, machine manufacturers, household heating and high volume of automobile traffic are all major sources of pollution in the region.

    Methods: A five year study (2009-2013) followed yearly concentrations of principal atmospheric pollutants such as sulfur dioxide, dust, nitrogen dioxide, lead aerosols and hydrogen sulfide, and the way in which those levels had an effect on morbidity (outpatient and inpatient medical care) in the area. Statistical processing of data has been completed to represent and analyze the collected data in nonparametric and alternative format.

    Results: Atmospheric pollution affects human health directly through pathological changes in the human organism. The registered outpatient care provided for the period 2009-2013 is highest for diseases of the cardiovascular system (11.85%), the respiratory system (17.34%) and the genitourinary system (9.76%). The registered rate of hospitalization for the same period is for diseases of the digestive system (11.90%), the cardiovascular system (11.85%), respiratory system (10.86%) and the genitourinary system (8.88%).

    Conclusion: The observed period shows a decrease in average yearly concentrations of the principal atmospheric pollutants in the industrial region (Bulgaria) and reflects a decrease in morbidity based on outpatient care and an increase in morbidity by inpatient care (hospitalization). Our findings should be corroborated in future longitudinal studies.



  • XML | PDF | downloads: 107 | views: 287 | pages: 523-530

    Background: Q fever is a zoonotic disease caused by Coxiella burnetii. There is no information about this disease in pregnant women in Iran. The aim of this study was to investigate the seroprevalence of C. burnetii infection among pregnant women in southwestern (Ahvaz) and northern (Parsabad) Iran and further to comparison its prevalence in normal and abnormal pregnancies.

    Methods: A total of 400 samples were collected randomly from pregnant women who referred to diagnostic laboratories of Ahvaz and Parsabad in 2014. An indirect ELISA kit, designed in Veterinary Faculty, was used to detect the specific antibodies against phase II humanC. burnetii in serum samples.

    Results: The overall prevalence of C. burnetii in sera from pregnant women was 29.3% (95% confidence interval (CI): 25-34%). The prevalence of C. burnetii infection was significantly different in Ahvaz and Parsabad with, respectively, 22 (95% CI: 16-28%) and 36.5% (95% CI: 30-43%). Total prevalence of C. burnetii infection in serum was significantly higher in women with abnormal pregnancy history (39.8%) compared with normal pregnancies (23.8%). Furthermore, maternal age had significant association with seropositivity and the prevalence increased with maternal age. This could be due to higher probability of encountering C. burnetii in older women.

    Conclusion: The present study demonstrated ahigh seroprevalence of C. burnetii infection among pregnant women in Iran for the first time. Seropositivity was associated with adverse pregnancy outcomes and maternal age. The pregnant women who experienced abnormal pregnancy had higher seroprevalence of C. burnetii compared to women with normal pregnancy.



Case Report(s)

Letter to the Editor