Vol 46 No 8 (2017)

Review Article(s)

  • XML | PDF | downloads: 601 | views: 770 | pages: 1007-1017

    Background: Diet plays a key role in the development of non-alcoholic fatty liver disease (NAFLD). The aim of this study was to review systematically observational studies available regarding the relationship between food intakes and NAFLD.

    Methods: We searched Scopus, PubMed, and Cochrane Library databases to identify English observational studies on food groups, dietary patterns, and NAFLD. Cross-sectional, case-control and cohort studies were selected and then duplication, topic, type of study, study population, variables examined and quality of data reporting of the articles were evaluated.

    Results: We identified 2128 studies in the initial search, of which 33 were reviewed in full text and 7 articles were included in this systematic review. Intakes of red meat, fats, and sweets were high whereas consumption of whole grains, fruits and vegetables were less in NAFLD patients. Moreover, there was a positive association between the Western dietary pattern and the risk of NAFLD, while adherence to the Mediterranean diet was significantly associated with the severity of hepatic steatosis.

    Conclusion: Generally, different food group intakes and dietary patterns are associated with the progression of NAFLD and its risk factors. Because of the many limitations of available studies reviewed on this topic, more prospective studies are suggested.



Original Article(s)

  • XML | PDF | downloads: 501 | views: 415 | pages: 1018-1027

    Background: Although the level of exposure to many toxic metals decreased recently, the adverse effects of these metals on children’s growth and development remain a serious public health issue.

    Methods: The present study was conducted in three teaching hospitals affiliated with Tehran University of Medical Sciences (Tehran, Iran) from Sep 2012 to Mar 2013. To study the relationship between metals and childhood growth, concentrations of zinc and several potentially toxic metals (lead, cadmium, antimony, cobalt, and molybdenum) were measured in scalp hair for 174 children, aged 20 to 36 months.

    Results: The hair concentrations of cobalt were significantly (P<0.05) higher in children at the lower percentile of weight than in higher-weight children (0.026 ± 0.04 vs. 0.015 ± 0.01 µg/g, respectively). Hair contents of lead, cobalt, and antimony were significantly higher (P<0.05) in girls than in boys (8.08 ± 8.7 vs. 4.92 ± 5.6 µg/g for lead, 0.026 ± 0.03 vs. 0.16 ± 0.02 µg/g for cobalt, and 0.188 ± 0.29 vs. 0.102 ± 0.12 µg/g for antimony). There were also significant correlations between lead and other metals in the children’s hair.

    Conclusion: Gender may play a significant role in absorption and/or accumulation of metals. It should be considered when we study metal toxicity in children.



  • XML | PDF | downloads: 483 | views: 403 | pages: 1028-1037

    Background: This study aimed to identify the association between health-related quality of life and mental health by elderly Koreans’ occupational status.

    Methods: This descriptive cross-sectional study consisted of a secondary analysis of data from the Korea National Health and Nutrition Examination Survey V-3 (2012). The sample comprised 1431 people aged 65 yr and older.

    Results: Compared to participants employed, those not showed lower HRQOL. Occupational status significantly affected all of the EuroQoL-5 Dimensions (EQ-5D): mobility, self-care, usual activity, pain/discomfort, and anxiety/depression. Unemployed participants had more suicidal ideation. Among employed elderly persons, significant differences were found between manual and non-manual workers in the EQ-5D index and EQ-5D for mobility and pain/discomfort. Manual workers experienced more depression and suicidal ideation than did non-manual workers.

    Conclusion: The occupational status of elderly individuals accounts for differences in their quality of life and mental health status. Therefore, additional jobs should be created for the elderly in order to improve their quality of life and mental health.


  • XML | PDF | downloads: 308 | views: 626 | pages: 1038-1045

    Background: The current overweight and obesity guidelines based on the Westerners are not consistent with many studies based on the Asians. The guidelines may be different because of regional diversity. This study aimed to determine the appropriate body mass index (BMI) and waist-hip ratio (WHR) cutoff points in the adults of Northeast China.

    Methods: Overall, 21206 adults were selected from Jilin Province Adult Chronic Disease and Risk Factor Survey conducted in 2012. A representative sample was collected in the Jilin Province of northeast China by a multistage stratified random cluster sampling design. The age of participants was from 20 to 79 yr old. The test items were clustered by risk factors, and receiver operating characteristic (ROC) curves were computed to analyze.

    Results: Under different risk factors, BMI cutoff points were affected greatly. Especially for diabetes, the cutoff value was apparently larger than others were. WHR increased with age in both genders. From a general view, male WHR was slightly larger than female. In the male, WHR cutoff point was near 0.88 with a tiny change, as for in the female was near 0.86.

    Conclusion: The cutoff values of sensitivity and specificity are relatively good and false positives rate is relatively low. BMI cutoffs values of overweight and obesity are 24.5 kg/m2 and 29.0 kg/m2, WHR cutoff values of the male are 0.88, the female is 0.86.



  • XML | PDF | downloads: 267 | views: 348 | pages: 1046-1053

    Background: Chronic obstructive pulmonary disease (COPD) is a major cause of mortality characterized by progressive airflow obstruction and inflammation in the airways, which has an impact on health-related quality of life. The EQ-5D-5L is one of the most used preference-based, health-related quality of life questionnaire. The objective of this study was to provide normative values of EQ-5D-5L for Spanish people suffering from COPD.

    Methods: Data were extracted from the Spanish National Health Survey (2011/2012). Overall, 1130 people with COPD participated in this survey. The utility index of EQ-5D-5L and the Visual Analog Scale (VAS) score were defined by gender, region, and age.

    Results: Mean (SD) EQ-5D-5L utility index and VAS score for Spanish people with COPD were 0.742 (0.309) and 60.466 (21.934) respectively. In general, men reported better health status than women. Ceiling effect of the whole sample was 30.35%.

    Conclusion: The current study provides normative values of EQ-5D-5L for Spanish people affected by COPD. Ceiling effect was high and better results were observed in men compared with women.



  • XML | PDF | downloads: 336 | views: 462 | pages: 1054-1061


    Background: Lung cancer is a serious threat to human health and life worldwide. Anxiety is common amongst palliative care patients with lung cancer and adversely affects quality of life. Acupuncture is an effective and safe treatment method used for the treatment of depressive mood status. We aimed to assess the influence of electrical acupuncture stimulation on self-reported anxiety in palliative care among patients with lung cancer.

    Methods: This pilot study had an experimental, 3-group, research plan. A total of 188 participants were enrolled from the Shanghai Pulmonary Hospital, Tongji University, Shanghai, China from 2014-2015. This pilot study had an experimental, 3-group, research plan. In TEAS group, participants received standardized palliative care and electrical acupuncture stimulation in Zusanli, Sanyinjiao and Hegu acupoints. Group MS received standardized palliative care and muscle stimulation nearby nonacupoint. Controlled group received standardized palliative care. The patients maintained their assigned acupuncture stimulation for 7 days. Demographic Instrument, Karnofsky Performance Scale Index, SF-16 health questionnaire and Self-Rating Anxiety Scale (SAS) were used.

    Results: The mean SAS scores in TEAS Group before and after electrical intervention in palliative care intervention were 31.17±7.55,34.58±13.98 and 27.86±6.73, (P=0.00) QoL score showed elevation from 57.13 in 8th day to 60.12 in 28th day, rising further to 5%. Comfort Score showed continuous elevation trend for 28 days.

    Conclusion: Electric acupuncture stimulation could reduce the anxiety of patients, promote rehabilitation and increase the quality of life among patients with lung cancer in palliative care.



  • XML | PDF | downloads: 292 | views: 399 | pages: 1062-1070

    Background: This study aimed to evaluate health literacy levels of patients in Almaty City, Kazakhstan and to identify socio-demographics and socio-economic factors related to their health literacy.

    Methods: An international survey instrument HLS-EU-Q developed by the European Health Literacy Consortium was used in a cross-sectional study with 1000 citizens in the Almaty City at the age of 18 and over who visited the outpatient departments in the polyclinics between Feb and Oct 2014.

    Results: There were 552 women and 446 men completed the survey, with mean ages as (41.8 ± 13.9) and (44.7 ± 15.2) yr old respectively, and women were significantly younger than men (P<0.001). Their general health literacy was (34.0 ± 8.6) for men and (33.49 ± 9.4) for women, without significant difference. In them, 15.5% or 30.0% were with inadequate or problematic health literacy. Multivariate linear regression analysis showed that higher general health literacy was positively and significantly associated with high self- assessed social status (B=3.86, P<0.001), ability to pay for medications (B=3.42, P<0.001), low frequency of watching health related TV programs (B=2.37, P<0.001), moderate community involvement (B=2.23, P=0.03).

    Conclusion: Specific demographic and socio-economic determinants related to health literacy were identified the first time in Kazakhstan. This would facilitate programs to improve health outcomes in Kazakhstan.


  • XML | PDF | downloads: 280 | views: 344 | pages: 1071-1078

    Background: Rheumatoid arthritis is an autoimmune inflammatory rheumatic disease that causes chronic synovial inflammation eventually leading to joint destruction and disability. The aim of this study was to determine the variations of hepatic proteins, myeloperoxidase, and iron in rheumatoid arthritis Tunisian patients and their implications in inflammation and in iron metabolism.

    Methods: Overall, 172 patients from the Rheumatology Department of the University Hospital “Farhat Hached”, Sousse-Tunisia between 2011 and 2012, with rheumatoid arthritis (97.1% women, average age: 48±13 yr) and 147 healthy volunteers (70.1% women, average age: 46± 7 yr) were included in this study. Serum hepatic proteins (high-sensitive C-reactive protein, ceruloplasmin, albumin, transferrin, α-1-acid glycoprotein and haptoglobin) were assessed by immunoturbidimetry (COBAS INTEGRA 400, Roche) and ferritin was measured by a microparticulate immunoenzymatic technic (AxSYM, ABBOTT, Germany), Plasma myeloperoxidase was determined by Enzyme-Linked Immunosorbent Assay. Serum iron was measured according to a colorimetric method at 595 nm (CX9-BECKMANN Coulter-Fuller-Ton, CA).

    Results: Significantly higher levels of high-sensitive C-reactive protein, α-1-acid glycoprotein, Haptoglobin and myeloperoxidase in patients compared to controls (P<10-3). Albumin and iron rates were significantly decreased in patients compared to healthy group (P=0.026 and P<10-3, respectively). There were no differences between cases and controls for levels of ceruloplasmin, transferrin and ferritin (P=0.782, P=0.808, and P=0.175, respectively).

    Conclusion: The high-sensitive C-reactive protein, α-1-acid glycoprotein, and haptoglobin increased in acute phase proteins in rheumatoid arthritis disease. The pro-inflammatory cytokines affect iron metabolism leading to the iron deficiency and rheumatoid anemia, which influenced Tf and ferritin levels.

  • XML | PDF | downloads: 243 | views: 241 | pages: 1079-1085

    Background: We aimed to explore the prognosis and risk factors influencing tumor recurrence in surgery-treated patients with primary sacral tumors.

    Methods: Fifty-six patients between February 2011 and December 2016 in Yishui Central Hospital with primary sacral tumors were selected and treated with radical surgeries. The perioperative outcomes and postoperative neurological functions were observed. After postoperative follow-up, the overall survival time (OS), disease-free survival time (DFS), and recurrence were recorded to analyze the potential risk factors influencing tumor recurrence.

    Results: The average surgical duration and intraoperative hemorrhagic volume were 3.92 ± 1.46 h and 2, 348.21 ± 813.67 ml, respectively. The postoperative short-term complications included three patients with infection from obstructed drainage and two with skin flap necrosis-induced infection, who recovered after anti-infection therapies; nine with incision-edge necrosis; two with calf muscle venous thrombosis; and one with an endorhachis cerebrospinal fluid fistula, who recovered after conventional treatment. Among patients, the 1-, 2- and 3-year survival rates were 91.07% (51/56), 82.14% (46/56), and 75.00% (42/56) while the 1-, 2- and 3-year DFS rates were 89.29% (50/56), 78.57% (44/56) and 71.43% (40/56), respectively. Of the 56 patients, 16 had recurrence after surgery, with recurrence rate of 28.57%. It was predicated that surgical methods and local infiltration were the independent risk factors influencing tumor recurrence (P<0.01).

    Conclusion: The reservation of bilateral S3 or > unilateral S3 nerves can improve quality of life of patients. Surgical methods and local infiltration are the independent risk factors influencing tumor recurrence, and extensive resection can effectively control the recurrence rate.


  • XML | PDF | downloads: 280 | views: 395 | pages: 1086-1094


    Background: This study was conducted to evaluate the incidence of medication discrepancies and its related factors using medication reconciliation method in patients admitted to the emergency department of Tehran University of Medical Sciences hospitals.

    Methods: In this cross-sectional study, 200 adult patients with at least one chronic disease that used two regular prescription medications were included in 2015. After 24 h of admission, demographic data and patient's home medications were collected. Medication discrepancies were assessed through comparison of a best possible medication history list with the physician's orders.

    Results: Out of 200 patients (mean age, 61.5 yr; 86 males, 114 women), 77.5% of patients had one or more medication discrepancies. The most common discrepancies were medication omission (35.49%), change (14.22%) and substitution (10.97%), respectively. The relationship between number of comorbid conditions (P=0.025), regular home medications (P=<0.001), high-risk medications (P=0.032), medications pharmacological classes (P=<0.001) and medication discrepancies were statistically significant. Cardiovascular drugs compared to other medications classes showed the highest discrepancies (36.2%). Multiple logistic regression showed that the drug groups, including anti-infective for systemic use (OR=8.43; 95%CI 2.5-28.2; P=0.001), Antineoplastic and Immuno-modulator Agents (OR=0.49; 95%CI 0.27-0.87; P=0.016), Blood and Blood-Forming Organs (OR=0.33; 95%CI 0.21-0.52; P<0.001), Muscular-Skeletal System (OR=2.4; 95%CI 1.13-5.1; P=0.022), Nervous-System (OR=2.75; 95%CI 1.7-4.4; P<0.001), Respiratory-System (OR=0.38; 95%CI 0.22-0.67; P=0.001) were associated with the drug discrepancy.

    Conclusion: A medication discrepancy occurs commonly at hospital emergency department. Understanding the type and frequency of discrepancies with using structured medication reconciliation process can help clinicians to prevent them.




  • XML | PDF | downloads: 256 | views: 316 | pages: 1095-1103

    Background: Researchers and academic institutions need assessment and rating to measure their performance. The criteria are designed to evaluate quality and adequacy of research and welcome by most universities as an international process to increase monitoring academic achievements. The study aimed to evaluate the increasing trend in global ranking of Iranian medical universities websites emphasizing on comparative approach.

    Methods: This is a cross-sectional study involving websites of Iranian medical universities. Sampling was conducted by census selecting universities affiliated to the Ministry of Health in webometrics rating system. Web sites of Iranian medical universities were investigated based on the webometrics indicators, global ranking as well as the process of changing their rating. Universities of medical sciences were associated with improved ratings in seven periods from Jan 2012 until Jan 2015.

    Results: The highest rank was in Jan 2014. Tehran University of Medical Sciences ranked the first in all periods. The highest ratings were about impact factor in universities of medical sciences reflecting the low level of this index in university websites. The least ranking was observed in type 1 universities.

    Conclusion: Despite the criticisms and weaknesses of these webometrics criteria, they are critical to this equation and should be checked for authenticity and suitability of goals. Therefore, localizing these criteria by the advantages model, ranking systems features, continuous development and medical universities evaluation based on these indicators provide new opportunities for the development of the country especially through online media.



  • XML | PDF | downloads: 282 | views: 320 | pages: 1104-1109

    Background: Basal Cell Carcinoma (BCC) is one of the most common skin cancers in the world and that use to lifestyle, increasing chemical pollutions, environmental factors and poor nutrition. The most important cause of this cancer is oxidative stress and free radicals so antioxidant activities for the body are so important. The aim of this study was to determine the variation of zinc and (Malondialdehyde) MDA in BCC patients.

    Methods: This study has been performed on case and control patients from 2013 to 2014. The samples were collected from cell carcinoma patients at Razi Hospital in Tehran, Iran. We evaluated the level of zinc with the use of Atomic Absorption Spectroscopy (AAS) method. Besides, we evaluated MDA with colorimetric assay.

    Results: The concentration of MDA was significantly higher in case group in comparison to control group (P=0.001). In addition, case group had lower concentration of zinc than the control group (P=0.000). There was no correlation between MDA and body mass index (BMI) and between zinc and BMI.

    Conclusion: All the patients with BCC showed a significant MDA serum in comparison with control group. However, significant decrease in zinc serum of the patients was seen that is because of consuming zinc during oxidative stress process so topical use of zinc in the form of 2+ ions could be effective on antioxidant protection against the sun UV radiation.



  • XML | PDF | downloads: 269 | views: 289 | pages: 1110-1117

    Background: We evaluated factors that affect malignant transformation of leukoplakia in a sample of the Iranian population.

    Methods: The records of patients with a clinical diagnosis of leukoplakia during a 20-year period from 1989-2009 referred to two of the largest referral centers in southern Iran were studied. Patients that developed malignant transformation were compared with patients that did not have malignant changes.

    Results: Of 522 patients, female patients, those over 50 yr old and with lesions located on the tongue had the highest rate of malignant changes. Female patients with malignant changes were mostly non-smokers (76.4%), while male patients with malignant changes were mostly smokers (63.8% in non-smokers) (P<0.001). In our univariate analysis, male sex and smoking showed lower chances for malignant transformation (OR: 0.57; CI=0.397-0.822 and OR: 0.025; CI=0.141-0.299, respectively), while age above 50 was a risk factor for malignant transformation (OR: 3.57; CI=2.32-5.42). In the multivariate analysis, smoking (OR: 0.317; 95% CI=0.16–0.626) and morphological presentation as erythroplakia (OR: 0.025; 95% CI=0.005-0.131) had low chances for developing malignant changes, while site of lesion on the tongue (OR: 774; 95% CI=60-9838) and morphological presentation as erythroleukoplakia (OR: 6.26; 95% CI=3.16-12.38) were a risk factor for developing malignant changes

    Conclusion: A follow-up program and further work-up should be considered for Iranian patients who have a leukoplakia lesion that is flat and are white patch or plaques with red components, in addition for patients who have lesions located on the tongue and for nonsmokers who develops leukoplakia lesions.



  • XML | PDF | downloads: 258 | views: 349 | pages: 1118-1122

    Background: The opportunistic fungi, particularly Candida glabrata has been known as main etiologic agents of life-threating infections in some patients. Although fluconazole is the most effective antifungal agent against candidiasis, C. glabrata, fluconazole-resistant strains have been increased recently overexpression or mutations of ATP-binding cassette (ABC) transporter family membrane proteins such as; Cg CDR1, Cg CDR2 are responsible for fluconazole resistance in a large proportion of candidiasis cases. The aim of this study was to evaluate CDR1 gene expression level as one of main mechanism involved in this resistance using.

    Methods: Candida glabrata strains were collected from various clinical samples in hospitals of Tehran in 2015 . After validation of all isolates by conventional and molecular methods, the susceptibility analysis to fluconazole of all isolates was performed using CLSI broth microdilution M27-A3 and M27-S4 protocols. Two isolates have been selected based on difference in susceptibility and CDR1-mRNA expression level of isolates was measured by Real-time PCR method.

    Results: Susceptibility results revealed that 32%, 64% and 4% of strains were susceptible, dose-dependent (DD) and resistant to fluconazole respectively. Furthermore, resistance strain of C. glabrata (MIC≥64 µg/ml) showed overexpression of CDR1 compared with sensitive strain in Real-time PCR analysis.

    Conclusion: Thus, it is necessary to investigate the functions of CgCDR1 genes as a transporter-related gene.



  • XML | PDF | downloads: 240 | views: 363 | pages: 1123-1131

    Background: The number of deaths related with co-infection of tuberculosis (TB) and HIV remains inappropriately high worldwide. TB is anticipated to be the major reason of HIV-related deaths globally. This study aimed to find out and evaluate the characteristics of the possible risk factors influencing the survival time of co-infected patients with HIV/TB in Tehran the capital of Iran.

    Methods: This retrospective study was performed on the referred patients to the one of two Behavioral Diseases Coun­seling Centers, Imam Khomeini, and Zamzam Centers, Tehran, Iran, in 2004-2013. Data were analyzed by Cox PH model utilizing SPSS16 statistical software.

    Results: Multivariate analysis confirmed that the age at diagnosis (P=0.014), gender (P=0.002), sexual transmission (P=0.01), cotrimoxazole preventive therapy (P<0.001), and onset to TB after post-HIV diagnosis (P=0.01) were the parameters which had significant effects on the death of HIV/TBco-infected patients.

    Conclusion: The results, recommend interplay between different risk factors and the risk of death in co-infected patients with HIV/TB. We presented the barriers to higher-level organizational and functional integration for commitment to interfere with the modifiable risk factors, which effect on the mortality of patients.


  • XML | PDF | downloads: 264 | views: 348 | pages: 1132-1138

    Background: Cystic echinococcosis (CE) is a zoonotic disease with global prevalence, which causes considerable health problems and economic losses throughout the world. The aim of this study was to assess the seroepidemiology of CE in Doroud City, Lorestan Province, Iran, considered a neglected endemic location.

    Methods: An ELISA was performed using recombinant AgB from Apr to Jul 2015 in Lorestan Province, Western Iran. The commercial Hydatidosis IgG ELISA kit (Vircell SL, Granada, Spain) was used to confirm the obtained results.

    Results: In the present study, out of 927 collected sera, 25 samples (2.6%) were found as seropositive for E. granulosus IgG antibodies. The prevalence of IgG antibodies against E. granulosus was significantly higher in rural areas (3.24%) than in urban area (1.20%) (P<0.001). Moreover, there was no significant relationship between age, occupation, sex, and literacy with seropositivity (P>0.05). Moreover, there was no statistically significant difference between the prevalence of CE in males (13/349, 3.72%) and females (12/553, 2.12%). With regard to occupation, farmers and ranchmen had the highest rate of infection (5.5%). There was a significant association between eating unwashed vegetables and seropositivity (P<0.001). Seropositive cases in rural areas were more than in urban areas.

    Conclusion: Since all the seropositive cases used unwashed local vegetables, the contamination may occur through the consumption of such vegetables.


Letter to the Editor