Vol 47 No 4 (2018)

Review Article(s)

  • XML | PDF | downloads: 269 | views: 319 | pages: 466-472

    Background: Vitamin D might be promising to serve as an adjunctive therapy for pulmonary tuberculosis (TB). However, the results remained controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of vitamin D in patients with pulmonary TB.

    Methods: Medline, SCOPUS, Google Scholar, EMBASE, Springer, and Science Direct were searched electronically from inception to Oct 2016. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) assessing the effect of vitamin D plus anti-tuberculosis treatment (ATT) versus placebo plus ATT on the treatment of pulmonary TB were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. Data were analyzed using RevMan 5.3 software.

    Results: Five studies were included in this meta-analysis. Overall, compared with placebo intervention, vitamin D supplementation was found to have no significant effect on sputum smear negative conversion rates (RR=0.99; 95% CI=0.91 to 1.07; P=0.77), BMI (MD=0.11; 95% CI=-0.85 to 1.07; P=0.82) and ESR (MD=-2.29; 95% CI=-8.87 to 4.30; P=0.50).

    Conclusion: Vitamin D supplementation showed no influence on the improvement of sputum smear-negative conversion rates and BMI, as well as the decrease in ESR.


  • XML | PDF | downloads: 326 | views: 517 | pages: 473-480

    Background: Metabolic syndrome (MS)is a collection of metabolic disorders which leads to early cardiovascular disease and diabetes type II. Regarding the wide range of its prevalence in Iran, this systematic review and meta-analysis determined the overall prevalence of the metabolic syndrome in Iran.

    Methods: In this systematic review and meta-analysis, the Medline, ISI, IranMedex, and SID were searched using "metabolic syndrome", "syndrome X", "prevalence", and "Iran" keywords from 2002 to 2012. A total of 223 articles were found in which 14 studies were considered for meta-analysis. Data were analyzed using fixed and random model and meta-regression in STATA.

    Results: The prevalence of MS for those who were 20 yr and older was 23. 8% (95%CI: 18. 99-28. 67) and in under 20 was 10. 98% (95%CI: 7. 75-14. 2). Metabolic syndrome was more frequent in women (25. 5%) than in men (17. 16%) and was increased with increasing age. The most frequent component of metabolic syndrome was low HDL cholesterol (59. 7%) followed by hypertriglyceridemia (39. 5%).

    Conclusion: Regarding a high prevalence of metabolic syndrome and some of its components such as low HDL and high triglyceride in our country, implementation of programs for metabolic syndrome prevention is necessary.


Original Article(s)

  • XML | PDF | downloads: 285 | views: 242 | pages: 481-488

    Background: The aim of this study was to explore the comorbidity of Attention-Deficit Hyperactivity Disorder (ADHD) for the Korean national health insurance data (NHID) by using association rule mining (ARM).

    Methods: We used data categorized mental disorder according to the international classification of disease, 10th revision (ICD-10) diagnosis system from NHID from 2011 to 2013 in youths aged 18 yr or younger. Overall, 211420 subjects, comorbid cases with ADHD were present in 105784. ARM was applied to the Apriori algorithm to examine the strengths of associations among those diagnosed, and logistic regression was used to evaluate the relations among rules.

    Results: The most prevalent comorbid psychiatric disorder of ADHD youths was mood/affective disorders. From results of ARM, nine association rules (support≥1%, confidnce≥50%) were produced. The highest association was found between specific developmental disorders of scholastic skills and ADHD. Among association of three comorbid diseases, tic disorder was an important role in the association between ADHD and other comorbid diseases through results of ARM and logistic regression.

    Conclusion: The practical application of ARM for discovering the comorbidity of ADHD in large amount real-data such as the Korean NHID was mostly confirmed by past studies. The results of this study will be helpful to researchers evaluating the stability of their diagnosis in ADHD.


  • XML | PDF | downloads: 259 | views: 339 | pages: 489-498

    Background: We presented the running state of rural basic medical insurance system in Henan and discussed the enforcements and development experiences of underdeveloped areas. We provided data evidence to support the improvement and development of a basic rural medical insurance system.

    Methods: We selected Henan Province, China as a sample, using the method of cluster sampling, from policy documents published in the national and provincial level of the new rural cooperative medical policy and work documents, data from 2004 to 2014, the National Health Statistical Yearbook of health statistics yearbook of Henan Province and relevant statistical data of the province.

    Results: The new rural cooperative policy has covered the whole population in Henan Province. The number of individual received benefits is increasing. In 2013, the number of persons counted has reached to 270 million, funds raised and expenditures reached 38.5 billion and 26 billion, respectively. The operational task force has been developed rapidly. In 2013, on average each staff managed the cases for 16.4 thousand rural residents.

    Conclusion: The major implementation and development experience from the new rural cooperative policy of Henan province include: education of related knowledge, optimization of compensation plan, development of operational system and framework, improvement of management rules, reinforcement of information system development and financial supervision and increment of investment in rural medical healthcare.



  • XML | PDF | downloads: 280 | views: 459 | pages: 499-509

    Background: Climatic and weather factors become important determinants of vector-borne diseases transmission like malaria. This study aimed to prove relationships between weather factors with considering human migration and previous case findings and malaria cases in endemic areas in Purworejo during 2005-2014.

    Methods: This study employed ecological time series analysis by using monthly data. The independent variables were the maximum temperature, minimum temperature, maximum humidity, minimum humidity, precipitation, human migration, and previous malaria cases, while the dependent variable was positive malaria cases. Three models of count data regression analysis i.e. Poisson model, quasi-Poisson model, and negative binomial model were applied to measure the relationship. The least Akaike Information Criteria (AIC) value was also performed to find the best model. Negative binomial regression analysis was considered as the best model.

    Results: The model showed that humidity (lag 2), precipitation (lag 3), precipitation (lag 12), migration (lag1) and previous malaria cases (lag 12) had a significant relationship with malaria cases.

    Conclusion: Weather, migration and previous malaria cases factors need to be considered as prominent indicators for the increase of malaria case projection.



  • XML | PDF | downloads: 227 | views: 240 | pages: 510-518

    Background: We aimed to investigate the relationship between serum soluble Klotho protein (sKlotho) level and coronary artery calcification (CAC) as well as prognosis in patients with maintenance hemodialysis (MHD).

    Methods: Overall, 128 adult patients with end-stage renal failure treated with MHD were collected in the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Province, China in 2013. Serum sKlotho was detected by ELISA and coronary artery calcification was measured by multi-slice spiral computed tomography (MSCT). With 36 months' follow-up, death notes such as cause of death and death time were recorded.

    Results: Patients were divided into low sKlotho group and high sKlotho group. Age, blood phosphorus level, hypertension incidence and incidence of diabetes mellitus of the patients in low sKlotho group was significantly higher than that of high sKlotho group (P<0.05). The coronary artery calcification score (CACs) of patients in high sKlotho group was significantly lower than that of low sKlotho group (P<0.001). Logistic regression showed that the decrease of sKlotho level (P<0.001) was an independent risk factor for CAC progression. The mortality of the patients in low sKlotho group was higher than that of high sKlotho group. Kaplan-Meier survival curve had shown that survival time of the patients in low sKlotho group was significantly lower than that of high sKlotho group (P<0.05).

    Conclusion: SKlotho can increase the degree of CAC. Although MHD patients with low sKlotho level had shorter survival time, sKlotho is not an independent risk factor in prediction of prognosis of MHD patients.


  • XML | PDF | downloads: 231 | views: 249 | pages: 519-530

    Background: Colorectal cancer is one of the most common malignancies in developed countries. The incidence of colorectal cancer (CRC) in Taiwan is rising. We aimed to determine the five-yr survival rate of patients diagnosed with CRC and determine factors affecting survival.

    Methods: All patients were identified from the Taiwan Cancer Data Base of the Medical Center Hospital in North Taiwan from 2007 to 2013. Data were collected using medical records and the cancer database. In all, 869 patients with CRC were included. Survival analysis was performed using Kaplan-Meier curves, and differences between the curves were analyzed using the log-rank test. Cox proportional hazards regression models were used to analyze survival by each variable.

    Results: The five-yr survival rate and the mean survival time after cancer diagnosis were 68.7% and 71.27±1.27 months. Perineural nerve invasion, distant metastasis, age, pathological differentiation grade, obstruction and regional lymph node metastasis were found to be independent predictors of the survival and prognosis of patients with CRC.

    Conclusion: Perineural nerve invasion was an important factor related to the survival of CRC patients. Thus, the earlier detection of CRC might help improve survival.


  • XML | PDF | downloads: 215 | views: 237 | pages: 531-537

    Background: To investigate the effect of psychological intervention on nutrient status of perioperative patients with lung cancer.

    Methods: Overall, 176 lung cancer patients admitted to Shanghai Pulmonary Hospital, Shanghai China from 2015 to 2016 were divided into control group (n=88) and study group (n=88). Conventional nursing strategy was adopted for patients in control group, while psychological nursing strategy was implemented for those in the study group, and the specific nursing efficiency was compared between the two groups. In addition to the assessment with Symptom Checklist 90 (SCL-90) and Quality of Life Questionnaire-Core 36 (QLQ-C30), patients were required to fulfill the evaluations with nutrition risk screening 2002 (NRS2002) and Patient-Generated Subjective Global Assessment (PG-SGA).

    Results: After nursing care, significant amelioration in scores of SCL-90 and QLQ-C30 of patients were seen in the study group (P<0.05). In the study group, the scores of NRS2002 and PG-SGA were all lower than those in the control group (P<0.001). Besides, PG-SGA score was also significantly correlated with the levels of serum total proteins, serum albumin, hemoglobin, reduction in diet and weight (P<0.01), while only reduction in diet and weight was obviously correlated with the score of NRS2002 (P<0.01). Moreover, a significant correlation was identified between the scores of PG-SGA and NRS2002 (P<0.01).

    Conclusion: Psychological intervention could effectively alleviate the psychological stress response and ameliorate the nutrient status of lung cancer patients in perioperative period, thereby reducing the negative feelings and increasing the life quality of patients.


  • XML | PDF | downloads: 195 | views: 330 | pages: 538-545

     Background: Physician-assisted suicide is one of the features with very different legal solutions in the world. In Serbia, physician-assisted suicide is a crime, within a crime of the assisted suicide. The possibility of the legislation of the voluntary active euthanasia may open the door to the decriminalization of the physician-assisted suicide.

    Methods: Data were obtained from the Clinical Hospital Center in Kragujevac, Republic of Serbia collected during 2015. The research included 88 physicians: 57 male physicians (representing 64.77% of the sample) and 31 female physicians (35.23% of the sample). Due to the nature, subject, and hypothesis of the research, the authors used descriptive method and the method of the theoretical content analysis.

    Results: We have raised numerous questions. A slight majority of the physicians (58%) believes that physician-assisted suicide should be legalized, while 42% is for another solution. 90.9% took a viewpoint that it is completely unacceptable legalization of the physician-assisted suicide for all age groups, while the remaining 9.1% is to such legislative move. From the other side, 40.7% of respondents would prescribe a lethal dose of the medicament to the patient, who is in the terminal stage of the incurable disease, but, 59.3% would not do it. Interesting is that 13.8% of the physician had a patient who asked for the information how to commit suicide, and 12.5% gave them such information.

    Conclusion: Physicians in Serbia are divided on this issue. The majority of them are for the legalization of medical assistance to suicide, but there is a strong division among them on various issues.



  • XML | PDF | downloads: 171 | views: 198 | pages: 546-552

    Background: The aim of this study was to investigate the correlation and interaction between the air pollution’s components with cardiopulmonary endurance of elderly people in eight regions by using a multi-modal and correlation analysis.

    Methods: The data of air pollution was collected in eight selected regions in 2013 to 2015. At the same time, total number of 880 male and female, older than 65 year-olds, were investigated based on the cardiopulmonary endurance measurement in the same regions. The correlation, interaction and multiple linear regressions was tested between the air pollution components in each region and cardiopulmonary endurance of elderly people, also between the air pollution components in each region and gender, respectively. In this case, the regression analysis for both hypotheses was conducted.

    Results: There was a correlation between the level of air pollution and cardiopulmonary endurance, especially for the carbon monoxide which has a strong effect, it was followed by the effect of sulfur dioxide and fine dust, meanwhile nitrogen dioxide seems not to be effective for this measurement test. Furthermore, it was highly unlikely that gender was a significant factor for the correlation between air pollution and cardiopulmonary endurance.

    Conclusion: The importance and correlation between air pollution and cardiopulmonary capacity is a critical determinant for the public health of a society, while at the same time having a serious impact on certain age groups. Provided that the factor of gender is highly unlikely to modify this impact, it is necessary to study the potential of other factors.



  • XML | PDF | downloads: 218 | views: 256 | pages: 553-560

    Background: Body pain is an important issue among elderly. The objective of this study was to access the association between the socioeconomic status and pain among elderly Chinese.

    Methods: This nationally representative sample cohort study, China Health and Retirement Longitudinal Study (CHARLS), was conducted to estimate pain prevalence and risk factors from Jun 2011 to Mar 2012. Body pain was evaluated by the questionnaires. Logistic regression model was applied to estimate the odds ratio (OR) and 95% Confidence Interval (95% CI) of body pain to identify the potential risk factors.

    Results: The prevalence of pain was increased with age (P<0.05). For moderate pain vs. no pain, doing agriculture job (OR 1.17; 95 CI 1.05-1.31), living in urban (OR 0.80; 95 CI 0.72-0.90), having a health problem (OR 1.55; 95 CI 1.20-1.99) is associated with moderate pain. For severe pain vs. no pain, primary school education (OR 0.65; 95 CI 0.54-0.78), junior high school education (OR 0.48; 95 CI 0.39-0.59), having a physical disability (OR 2.71; 95 CI 2.18-3.37), never drinker (OR 0.74; 95 CI 0.60-0.91), environment of urban (OR 0.54; 95 CI 0.46-0.63), having a health problem (OR 2.03; 95 CI 1.45-2.83) are associated with severe pain.

    Conclusion: Socioeconomic variables such as education, occupation and health conditions are associated with both moderate severe pains.



  • XML | PDF | downloads: 268 | views: 216 | pages: 561-566

    Background: The aim of this study was to conduct a sero-epidemiological survey in Alborz Province, central Iran to detect the rate of hydatidosis in the city and nearby villages.

    Methods: Overall, 680 serum samples were collected from 536 male and 127 female subjects referred to different health centers of Karaj, Alborz Province, central Iran and nearby villages in 2014-15. All patients filled out a questionnaire and an informed consent. Sera were analyzed using indirect-ELISA test with AgB. Ten μg /ml antigens (Proceeded hydatid fluid), serum dilutions of 1:500 and conjugate anti-human coombs with 1:10000 dilutions were utilized to perform the test. Data analysis was conducted using SPSS software ver. 11.5.

    Results: Twenty-three cases (3.4%) were positive for hydatidosis by ELISA test. The prevalence of hydatidosis among females and males was 3.1% and 4.7%, respectively. The rate of the disease was significantly higher in areas where dogs were higher (P<0.05). There was no significant difference as regards age groups, sex, job, residency, and literacy. Regarding occupation, housekeepers had the highest rate of infection as 5.9%. The sero-prevalence of infection was 4.2% in bachelors and master people which showed the highest rate. As regards residency, urban life showed no significant difference with rural life (2.8% vs. 4.4%). Age group of 30-39 yr old, with 4.3% as prevalence had the highest rate of positivity (P>0.05).

    Conclusion: Because of the specific situation of Alborz Province, and availability of many stray dogs, obtained rate of hydatidosis shows that the authorities should be cautious to monitor the disease.



  • XML | PDF | downloads: 217 | views: 268 | pages: 567-574

    Background: Bladder cancer is the fifth most common cancer in Iran. In this study, we aimed to assess the epidemiological status and calculate the hospitalization cost of bladder cancer patients in the southeastern part of Iran.

    Methods: This retrospective study reviewed the medical records of 243 patients admitted to a referral center for the treatment of bladder cancer patients in the southeastern part of Iran during the years 2014–2015 and extracted their pathologic and hospitalization cost data. Using Kruskal-Wallis and Mann-Witney tests, we investigated the association between hospitalization cost and other variables including sex, age, cancer grade, cancer histology, type of treatment and time from diagnosis.

    Results: About 53% of patients were in grade III or IV. More than half of them were non- muscle invasive (65%). The mean and median hospitalization costs per month were US$101 and US$72, respectively. The annual hospitalization cost for the first, second, and third year after diagnosis was estimated US$1608, US$840, and US$468 respectively. About 70% of patients were hospitalized only during the first year after diagnosis. In muscle-invasive bladder cancer, patients the average monthly hospitalization cost were about 2.1 times more than for non-muscle invasive patients (US$156 vs. US$76).

    Conclusion: Bladder cancer is a costly disease and its cost significantly varies with disease stage at diagnosis. Developing effective strategies for early detection of bladder cancer as well as careful surveillance programs for early diagnosis of recurrence could reduce the cost of this cancer.



  • XML | PDF | downloads: 170 | views: 203 | pages: 575-583

    Background: Type 2 diabetes mellitus (T2DM) is commonly associated with depressive symptoms, which affect prognosis and quality of life. We investigated the antidepressant effects of n-3 fatty acids (n-3FAs) monotherapy (without conventional antidepressants) for T2DM patients with mild to moderate depressive symptoms.

    Methods: A 10-wk, placebo-controlled, double-blind, parallel-group (1:1 ratio) randomized trial of n-3FAs (2700 mg/day EPA: DHA ratio=2) versus placebo in 88 Iranian diabetic patients with mild to moderate depression based on Beck Depression Inventory II (BDI-II-PERSIAN) was conducted. This study started from July 2014 to January 2015 in Tehran University of Medical Sciences, Tehran, Iran. The primary event was defined as worsened, non-changed, or inconsiderably improved depression (<5 unit decrease in BDI-II-PERSIAN depression scores after treatment) (ClinicalTrials.gov Identifier: NCT02261545).

    Results: Randomly, 44 T2DM patients were treated with n-3FAs supplements and 44 cases received placebo (three patients discontinued). n-3FAs could significantly protect patients against the aforesaid event and exhibit satisfactory prevention (number needed to treat with 95% confidence interval: 2.52, 1.71-4.74). No serious adverse reactions were reported.

    Conclusion: n-3FAs supplementation had significant antidepressant effects in T2DM patients with mild to moderate depressive symptoms, not confounded by metabolic factors and disease duration.



  • XML | PDF | downloads: 241 | views: 384 | pages: 584-590

    Background: Burn injuries are considered an important preventable cause of injuries in children, and it still produces significant death in Iran. This study investigated the causes and severity of burns in patients.

    Methods: This study was retrospective descriptive study of children-burn injury in a referral Burn Care Center in Tehran, Iran during a ten-year period since 2005 to 2014. Data collection have been facilitated by using a specially designed checklist. The subjects included 1717 consecutive patients with various causes of burn injury. Data were analyzed applying descriptive statistics, one-way ANOVA, Chi-square. P-values less than 0.05 were considered significant.

    Results: The patients’ mean age was 4.11 ± 3.42 yr. The mean hospitalization period was 11.15 ± 8.37 d. The grade of burn was 2 in 1292 (75.2%) patients. Among the children-burn patients, 59.9% suffered from <20% of total body surface area burn. Most affected part of the body was trunk 762 (44.4%). Overall, 1256 patients (73.2%) suffered from hot liquid burns. Burns mortality rate for this study was identified 8.1% (N=3).

    Conclusion: The majority of the patients were male with a male to female ratio of 1.7:1. Most patients were in the 2-4 yr age group, with most of the injuries occurring in boys under the age of 5 yr old. It is the child's natural curiosity and inability to understand that special things are dangerous to them, which leads to burning injury. Most affected part of the body was trunk and 1256 patients (73.2%) suffered from hot liquid burns.



Short Communication(s)

  • XML | PDF | downloads: 188 | views: 269 | pages: 591-596

    Background: The effect of weather conditions on human health has been documented. However, the role of daily weather on anticipated death remains unclear. This study aimed to evaluate the relationship between daily weather conditions and death in terminally ill cancer patients.

    Methods: We retrospectively searched a medical database of 935 consecutive terminally ill cancer patients who passed away in the palliative care unit from Oct 2009 to Sep 2013. We used Poisson regression to assess the relative risk (RR) of anticipated death based on various weather variables, using mean values calculated from the 10 d around the time of death.

    Results: The final study population consisted of 745 patients with a mean age of 65.9 ± 12.2 yr. The mean palliative prognostic index (PPI) score in the last week of life was 8.0 ± 3.8. After adjustment for age, sex, cancer type, and PPI score, RRs were 1.69 (95% CI, 1.17–2.46) for low temperature, 2.57 (1.77–3.77) for high diurnal temperature variation, 2.35 (1.61–3.36) for low humidity, and 1.75 (1.22–2.53) for high levels of sunlight.

    Conclusion: Weather conditions may be a predictor of death in terminally ill cancer patients.



Case Report(s)

  • XML | PDF | downloads: 162 | views: 180 | pages: 597-602

    Carney complex (CNC) is a rare genetic disease. Here, we report a case of CNC and explore clinical manifestations and gene mutation studies of CNC. A male patient with CNC at the age of 16 yr was admitted to Affiliated Hospital of Zunyi Medical University in July, 2015. Although the patient had typical signs of Cushing's syndrome, he also presented with certain rare signs of Cushing's syndrome, such as "freckle-like" scattered spots of pigmentation on the face and around the lips. In addition, concomitant severe osteoporosis led to flattened vertebrae and the compression of corresponding levels of the spinal cord. Radiographic findings revealed adrenal nodular hyperplasia. Based on sequencing, 2 novel heterozygous mutations of the PRKAR1A gene were found. CNC was eventually diagnosed via pathologic biopsy. After 1 year of follow-up, the patient exhibited weight loss, relief of low back pain, normal blood biochemical indicators and cortisol levels at the lower limit of the normal range.


Letter to the Editor