Vol 47 No 5 (2018)

Review Article(s)

  • XML | PDF | downloads: 278 | views: 226 | pages: 623-632

    Background: The aim of this study was to conduct a meta-analysis to estimate the association between the two SNPs and PCa risk.

    Methods: Medline, Embase, Scopus, PubMed, Web of Science, Wan Fang Database and Chinese Zhi Wang Database were searched for the association of the two SNPs with susceptibility to PCa. The effect size was pooled by odds ratios (ORs) and 95% confidence intervals (95% CIs).

    Results: Nine case-control studies, 5 on rs3787016 and 4 on rs2910164, were included. As regards rs3787016, an increased risk of PCa was identified in all genotype models (T versus C: OR = 1.18, 95% CI 1.11-1.25; CT versus CC: OR = 1.17, 95% CI 1.08-1.26; TT versus CC: OR = 1.41, 95% CI 1.22-1.63; TT + CT versus CC: OR = 1.20, 95% CI 1.12-1.30; TT versus CT + CC: OR = 1.32, 95% CI 1.15-1.52). However, no significant association was found between rs2910164 and PCa risk in any genetic models, in fact a trend of reduced risk could be seen (C versus G: OR = 0.91, 95% CI 0.79-1.05; GC versus GG: OR = 0.93, 95% CI 0.74-1.18; CC versus GG: OR = 0.70, 95% CI 0.47-1.02; CC + GC versus GG: OR = 0.90, 95% CI 0.73-1.12; CC versus GC + GG: OR = 0.78, 95% CI 0.56-1.08). Besides, in analysis of subgroups by source of controls, the decreased results were observed in studies using population-based controls.

    Conclusion: lncRNA POLR2E polymorphism rs3787016 is associated with a significantly increased risk of PCa, while a trend of reduced risk appears with mir-146a polymorphism rs2910164.


Original Article(s)

  • XML | PDF | downloads: 329 | views: 277 | pages: 633-640

    Background: Malnutrition, a very common condition in the elderly, is known to increase their vulnerability to adverse health events. This study aimed to estimate the prevalence of malnutrition in the over 75-yr-old community-dwelling population in the “Chiavarese” Local Health Unit district (North West Italy).

    Methods: The short version of the Mini Nutritional Assessment (MNA-SF) was used by General Practitioners (GP) as a screening tool to investigate the nutritional status of elderly people (1039 subjects). The study was conducted in 2012- 2013 in the Local Health Unit of Chiavari (Liguria Region), Italy. The malnutrition was subsequently confirmed by means of biochemical parameters. Subjects at risk of malnutrition or malnourished (n=22) received personalized dietary counseling by the GP.

    Results: The MNA-SF recognized 21% of the elderly people being at risk of malnutrition and biochemical tests confirmed a malnutrition prevalence of 3.5%. The dietary counseling improved the MNA-SF score and biochemical parameters, but the difference was statistically significant only for the MNA-SF score (P=0.00613).

    Conclusion: Malnutrition can be evaluated with a simple tool such as the MNA-SF, recognized at the earliest stage and successfully treated by the GP.



  • XML | PDF | downloads: 255 | views: 229 | pages: 641-647

    Background: We determined the diagnostic and therapeutic effects of SRM-IV vestibular function diagnosis and treatment system on benign paroxysmal positional vertigo (BPPV).

    Methods: Overall, 120 patients with BPPV diagnosed in the outpatient and in-patient departments of the Vertigo Treatment Center of the First People's Hospital of Xuzhou from January 2013 to December 2015 were selected for this study. They were randomly divided into three groups. Automatic repositioning procedure was conducted for 40 patients in the equipment repositioning group by SRM-IV vestibular function diagnosis and treatment system, conventional manual repositioning procedure was used for 40 patients in the manual repositioning group, and combination of treatment drugs (alprostadil and safflower injection) with acclimatization training was adopted in 40 patients in the drug therapy group.

    Results: After 1 week of treatment, the cure rate and total effective rate in the equipment repositioning group and the manual repositioning group were significantly higher than those in drug therapy group (P<0.05). The total effective rate was 100.0% in the equipment-repositioning group and 92.5% in manual repositioning group; the difference between the two groups was not statistically significant. The success rate of one-time treatment of anterior semicircular canal BPPV, posterior semicircular canal BPPV and lateral semicircular canal BPPV in the equipment-repositioning group were higher than those in the manual repositioning group were.

    Conclusion: The SRM-IV vestibular function diagnosis and treatment system are helpful in achieving effective and standard diagnosis and treatment of BPPV.


  • XML | PDF | downloads: 304 | views: 275 | pages: 648-657

    Background: To improve efficient and systematic management and following of healthcare-associated infection guidelines, the relationship among various factors must be understood. Efforts should be made to strengthen or reduce relevant factors. We developed a structural equation model for following HAI-control guidelines

    Methods: Overall, 388 Korean registered nurses participated in this study and data collection was conducted Jul 21-Aug 31, 2014 using a self-reported questionnaire, and 392 of 400 copies were collected (98% recovery rate). Data were analyzed using descriptive statistics, reliability, and Pearson’s coefficient. Model identification evaluation was conducted by goodness-of-fit index and impact analysis.

    Results: Results of goodness-of-fit of modified model were as follows: χ2=120.57 (df=16, P<.001), GFI (Goodness of Fit Index)=.95, RMSEA (Root-Mean-Square Error of Approximation)=.10, SRMR (Standardizes Root-Mean-Square residual)=.06, NFI (Normal Fir Index)=.90, CFI (Comparative Fit Index)=.90. Factors with a statistically significant direct impact on behavioral intention are as follows; perceived behavior control (β=.35, P=.008), subjective norm (β=.27, P=.002), and job demands (β=-.08, P=.083). Organizational factors directly influenced following guidelines. Explanatory power of organizational factors on guideline compliance was greatest (C.R. [Critical Ratio] =5.67, P<.001).

    Conclusion: Supportive leadership and a positive organizational culture development strategy are essential. The hospital leader group should provide adequate resources to facilitate compliance with guidelines as well as create an atmosphere of on-site support that ensures guidelines will be followed, and engage in continuous monitoring and feedback regarding following of guidelines.



  • XML | PDF | downloads: 230 | views: 208 | pages: 658-665

    Background: We aimed to investigate the prevalence of erectile dysfunction (ED) in patients with lower urinary tract symptoms (LUTS) and to explore the correlation of ED with LUTS and its clinical features.

    Methods: Overall, 400 outpatients and inpatients with LUTS diagnosed in Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, Henan Province, China from June 2015 to June 2017 were collected. LUTS degree was assessed by the International Prostate Symptom Score (IPSS), and ED degree was assessed by the International Index of Erectile Function (IIEF-5). The correlation of ED with LUTS degree, age, blood lipids, homocysteine (Hcy) and other factors was analyzed.

    Results: The prevalence of ED in patients with LUTS was 82.25%. With the increase in age, the prevalence of ED was significantly elevated, and ED degree gradually became higher (P<0.01). The higher the degree of LUTS was, the higher the prevalence of ED would be. The degree of ED was highly correlated with the combination with hypertension, diabetes mellitus and coronary heart disease (P<0.05). The prevalence of ED was positively correlated with LUTS degree and the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and Hcy (P<0.05 or P<0.01).

    Conclusion: ED prevalence of patients with LUTS is high, and ED is significantly related to LUTS degree, age and the levels of TC, LDL-C and Hcy in patients with LUTS.


  • XML | PDF | downloads: 271 | views: 307 | pages: 666-673

     Background: Incidence of falling in the older-elderly is higher than that of the younger-elderly. In addition, falls occur more in elderly women than in elderly men. However, it is unclear whether age and sex-specific differences exist in gait characteristics of the elderly. Therefore, the aim of this study was to investigate age- and sex-related differences in gait characteristics of the Korean elderly people.

    Methods: A total of 75 younger-elderly subjects (age of 65-74 yr; 21 men and 54 women) and 59 older-elderly subjects (age of 75-90 yr; 15 men and 44 women) participated in this study in 2014. All participants walked a distance of 8 m across a GaitRite walkway with self-selected speed. The effects of age and sex on spatiotemporal gait variables in the Korean elderly people were analyzed before and after adjusting height as covariate.

    Results: The older-elderly group slowly walked with shorter stride length (P<0.05) and step length (P<0.05) compared to the younger-elderly, regardless of their height. There was no significant sex difference after adjusting height as covariate, although elderly women walked with shorter stride length (P<0.01) and step length (P<0.01) than elderly men. The elderly women group walked with more variable stride time (P<0.05) and with longer double support (P<0.01).

    Conclusion: Age-related changes and sex difference among the elderly existed in specific gait variables. Characterizing gait patterns of the Korean elderly people considering both age and sex would be beneficial to assess gait of the elderly with risk of falls for fall interventions.


  • XML | PDF | downloads: 197 | views: 202 | pages: 674-681

    Background: To investigate the epidemiologic distribution of foodborne diseases in Wenzhou City from 2014-2015, we analyzed the characteristics and main pathogens of foodborne disease outbreaks to provide a reference for the prevention, control, and early warning of foodborne diseases.

    Methods: A total of 9139 patients with foodborne diseases were included in the database of active monitoring from sentinel hospitals in Wenzhou City, China. Salmonella, Shigella, Vibrio parahaemolyticus, enteropathogenic Escherichia coli, and norovirus in the stool samples collected from patients with foodborne diseases were detected according to national standards.

    Results: There were 82 cases of Salmonella, 6 cases of Shigella, 393 cases of V. parahaemolyticus, 9 cases of diarrhoeagenic E. coli, and 143 cases of norovirus in the 9139 stool and anal swab samples, for a total detection rate of 6.98%. The peak season in which foodborne diseases occurred was from Jun-Oct. The high-risk populations were the 0-5, 16-25, 26-35, 35-45, and 46-55 yr age groups. Aquatic products accounted for the greatest proportion of suspected food, followed by meat, poultry, fruits, and vegetables.

    Conclusion: V. parahaemolyticus was the main pathogen of foodborne diseases in the Wenzhou urban area; Salmonella and norovirus were also foodborne disease pathogens. To prevent foodborne diseases, it is necessary to strengthen active monitoring, especially the sanitary management of seafood.


  • XML | PDF | downloads: 324 | views: 357 | pages: 682-688

     Background: This study aimed to determine the prevalence and potential risk factors of obesity among women in Turkey.

    Methods: The data source was the Turkey Demographic and Health Survey (TDHS) in 1998, 2003, 2008 and 2013, conducted by Hacettepe University Institute of Population Studies. Cross-tables and binary logistic regression were used in the study.

    Results: Obesity was a serious problem among women in Turkey. Obesity rate was 21.7% in 1998 and increased to 26.5% in 2013. Age, education level, the number of births, region, residence, and wealth status were included as potential risk factors. Age was an important variable affecting obesity and increased with age. There was an inverse relationship between obesity and education level. Women having no education or not completed primary school and those who were not working were higher at obesity risk. Obesity increased with the giving births of mothers. Obesity was mostly observed in the West and Central. As household welfare increased, obesity increased except for 2013 research.

    Conclusion: Preventive interventions should be announced particularly among urban women in Turkey. Women should be stimulated by physical activities and informed by realistic food policies.


  • XML | PDF | downloads: 418 | views: 316 | pages: 689-697

    Background: The increasing number of graduate students in China has resulted in the wide concern for their mental health problems. The coping style and social support are important factors that affect the mental health of individuals. This study aims to explore the relationship of the mental health, social support, and coping style of graduate students.

    Methods: The sample consisted of 260 graduate students from three universities of China. The participants were evaluated using the Symptom Checklist-90 (SCL-90), Social Support Revalued Scale (SSRS), and Coping Style Questionnaire (CSQ) in October and November 2017. The data of the scale were analyzed with t-test, correlation, and multiple regression analysis.

    Results: The graduate students had lower scores than the national norm standard on all subscales, except for anxiety and phobic anxiety in the SCL-90. Graduate students’ mental health was significantly negatively correlated with social support, problem-solving, and help-seeking and significantly positively correlated with self-blame, fantasy, withdrawal, and rationalization. Coping style and social support affected the mental health of graduate students, in which the regression coefficients of the subscales of problem-solving, rationalization, self-blame, and fantasy were −0.168, 0.070, 0.125, and 0.113, respectively. The regression coefficients of the subscales of subjective and objective supports were −0.086 and −0.024, respectively.

    Conclusion: The positive coping style and social support improve the level of graduate students’ mental health through the gain effect and alleviate abnormal psychological symptoms. The conclusions of this study can provide a reference to improve the psychological intervention strategies for graduate students.


  • XML | PDF | downloads: 246 | views: 278 | pages: 698-705

    Background: The aim of this study was to investigate OCB among physicians in China and explore whether their job satisfaction mediates the association between doctor-patient relationship (DPR) and organizational citizenship behavior (OCB).

    Methods: This cross-sectional, questionnaire-based survey was conducted among 1400 physicians in Shaanxi, China in 2014. The subjects were selected using a multi-stage cluster sampling methodology. The self-administered questionnaires included OCB Scale, DDPRQ, and PJSQ. Hierarchical linear regression analysis was used to estimate the effects of job satisfaction on the association between DPR and OCB.

    Results: DPR negatively predicted four dimensions of OCB, including conscientiousness, sportsmanship, civic virtue, and altruism. DPR was negatively related to five job satisfaction dimensions, namely work satisfaction (WS), promotion satisfaction (PS), reward satisfaction (RS), supervision satisfaction (SS), and environment satisfaction (ES). WS was positively correlated with conscientiousness and civic virtue; PS and SS were positively related to all four OCB dimensions; RS was positively related with civic virtue and altruism, and ES was positively correlated with conscientiousness and civic virtue. WS and PS partially mediated the association between DPR and conscientiousness; PS and SS partially mediated the relation between DPR and sportsmanship; PS, SS, and ES mediated the association between DPR and civic virtue; and PS, RS and SS partially mediated the relation between DPR and altruism.

    Conclusion: Job satisfaction mediated the association between DPR and OCB among Chinese physicians. The poor DPR possibly reduce physicians’ job satisfaction, thereby causing a decline of OCB in hospitals. Therefore, DPR improvement and job satisfaction have a great potential to promote physicians’ job performance in China.



  • XML | PDF | downloads: 205 | views: 217 | pages: 706-712

    Background: Marginal Structural Models (MSMs) are novel methods to estimate causal effect in epidemiology by using Inverse Probability of Treatment Weighting (IPTW) and Stabilized Weight to reduce confounding effects. This study aimed to estimate causal effect of donor source on renal transplantation survival.

    Methods: In this cohort study, 1354 transplanted patients with a median 42.55 months follow-up in Namazee Hospital Transplantation Center, Shiraz from Mar 1999 to Mar 2009, were included to use marginal structural Cox regression, binomial logistic regression model to estimate causal effect of donor source on the survival of renal transplantation. IPTW and stabilized inverse probability of treatment weighting are used as weights.

    Results: The un-weighted (crude) hazard ratios for live unrelated donor and deceased donor in comparison to live related donor as reference group was (HR: 1.03, 95% CI: 0.58-1.83, P=0.89) and (HR: 2.69, 95% CI: 1.67-4.31, P=0.001), respectively. Using a marginal structural Cox regression model and by stabilized weight, the hazard ratios for live-unrelated donor and cadaveric donor were (HR: 1.08, 95% CI: 0.47-2.45, P=0.84) and (HR: 3.63, 95% CI: 1.59-8.26, P=0.002), respectively. There was no difference between estimated effect size from marginal structural Cox regression, marginal structural logistic regression, and marginal structural Weibull regression model.

    Conclusion: There is no difference between related and unrelated donor source hazard ratio; however, hazard ratio for cadaveric donor was 3.63 times of hazard ratio for related donor and 3.34 times of it for unrelated donor. Therefore, the live donor (related or unrelated) has a better survival of renal transplantation than cadaveric donor.


  • XML | PDF | downloads: 206 | views: 204 | pages: 713-719

    Background: Due to the widespread different pathogenic strains, Escherichia coli lead many severe to normal diseases worldwide. Finding the relation of clones with genomic content and clinical features is a key point to recognize the high potential-invasive strains. Specific virulence factors include adhesions, invasions, toxins, and capsule are the main determinants of pathogenic factors of E. coli strains.

    Methods: From Jun 2014 to Jun ‎‎2016, E. coli isolates recovered using standard bacteriological methods from wastewater sources in different hospitals in Tehran, Iran, were monitored to recognize the virulence genes by polymerase chain reaction (PCR) assay.

    Results: The high and low presences of virulence factors were fimH, 76% and afa, 13%, respectively.

    Conclusion: The results indicated the potential pathogenicity of E. coli strains circulating in hospital wastewaters in Tehran, Iran.



  • XML | PDF | downloads: 351 | views: 298 | pages: 720-728

    Background: To prevent health care errors, the main causes and preventive strategies should be identified. The purpose of this study was to identify the causes and preventive strategies of health care errors from the perspectives of physicians.

    Methods: We surveyed 250 randomly selected physicians in five teaching hospitals in Tehran, Iran, in 2015. We used a questionnaire with 29 questions regarding causes and 17 ones regarding the preventive strategies. The participants were asked to answer the questions based on Likert’s five-point score (1=very low to 5= very high). The data was analyzed using descriptive (frequency, and mean scores) and inferential statistics in SPSS.

    Results: Managerial factors (3.6±0.7), personal factors of providers (3.5±0.6), factors related to the patients (3.4±0.71), and the factors pertinent to laboratory and pharmacy (3.2±0.8) were the main causes respectively. The most important preventive strategies were improvement of academic education, better taking past medical history, implementing electronic prescription and increasing healthcare budget.

    Conclusion: Heavy workloads, long work shifts, failure to do thorough examination and to collect detailed history information, providers’ fatigue, patients’ reluctance to follow orders or to give their complete information, failure to give detailed instruction to patients about the medications, lack or insufficient monitoring and supervising systems, and lack of enough budget were some of the most important causes of errors. Using IT to access patients’ information, improving patients’ adherence, reducing workload, developing efficient methods for collecting patients’ information, dedicating adequate budget for improvement programs are recommended.



  • XML | PDF | downloads: 240 | views: 185 | pages: 729-734

    Background: Trichomonas muris is one of the most common protozoa diagnosed in rodents. The trichomonads are generally described as presenting only trophozoite form while pseudocyst is another morphological form of trichomonads identified among gastrointestinal and genitourinary trichomonads. We identified and described different shapes of T. muris pseudocysts and trophozoite in stool samples were collected from rodents including Merinos persicus, Mus musculus and Cricetulus migratorius.

    Methods: In this cross-sectional study, stool samples from 204 trapped rodents were collected from Meshkin Shahr during Mar to Dec 2014. Samples were preserved in formalin 10% and PVA solution and transferred to Department of Medical Protozoology and Mycology, School of Public Health, Tehran University of Medical Sciences. Formalin-ether concentration method was used for the samples. The slides were stained with trichrome staining method and observed under light microscope.

    Results: The trophozoites were classified as T. muris based on size (18 to 24 µm), presence of three anterior flagella, recurrent flagellum, undulating membrane, and axostyle in direct examination and stained slides with trichrome staining method.  Fifty-five out of 204 (27%) rodents were infected with T. muris in which 51(25%) samples pseudocysts form were observed. The spherical bodies of pseudocyst with almost 8 µm size, contained internalized flagella, an undulating membrane with recurrent flagellum, axostyle, and costa were seen. The pseudocysts were more prevalent than trophozoite form and pseudocysts were found with different shapes in this study.

    Conclusion: T. muris pseudocysts were found in stool samples of caught rodents for the first time in northwestern Iran.


Short Communication(s)

  • XML | PDF | downloads: 201 | views: 195 | pages: 735-741

     Background: Toll-like receptors (TLRs) of the human immune mechanism play important role in the detection of invading pathogens. TLRs specifically recognize the pathogen-associated molecular patterns (PAMPs) from pathogens and start the effective response. Single nucleotide polymorphisms (SNPs) in the TLRs can mediate their functions. Present study evaluated the importance of rs4986790 polymorphism of TLR4 gene in susceptibility towards malaria, clinical outcomes of the disease and responsible species of malaria.

    Methods: Blood samples of 228 malaria patients and 226 healthy volunteers were selected for the study. Sample collection was completed during Sep 2013 to Sep 2015 from different hospitals of Punjab, Pakistan. Patient's samples were divided into P. vivax group and P. falciparum group on the basis of causative species of Plasmodium. Malaria samples were also divided into mild and severe malaria group based on clinical outcomes of the disease according to WHO criteria. Healthy individuals were placed in the control group. Whole blood was used for the isolation of DNA. Genomic DNA was isolated and amplification of targeted SNP was performed using allele-specific PCR.

    Results: Results indicate the protective role of AA genotype against the susceptibility of P. vivax infection, OR: 0.5, 95%CI: 0.285- 0.876, P=0.038.

    Conclusion: rs4986790 polymorphism of TLR4 gene modulates the susceptibility towards P. vivax infection. AA genotype is found to be protective against the development of P. vivax infection in the local population of Pakistan.



  • XML | PDF | downloads: 203 | views: 266 | pages: 742-749

     Background: This study was carried out to determine the infestation of domestic ruminants to ticks in an important livestock-rearing region, located in central part of Iran.

    Methods: Ticks were collected from cattle, sheep, and goats and then were identified with appropriate identification keys to species level in two different ecological regions of plains and mountain in 4 seasons in 2015.

    Results: Totally 492 ticks from cattle, sheep, and goats in 34 herds were collected. Totally, 18.53% of domestic animals were infected by ticks. All ticks were belonged to family Ixodidae and classified into three genera and six species comprising Hyalomma anatolicum (38.83%), Hy. Asiaticum (23.37%), Hy. marginatum (2.85%), Hy. sp. (3.45%), Rhipicephalus sanguineus (14.02%) and Haemaphysalis sulcata (10.98%). Sex ratio of the collected specimens showed 241 (48.99%) male, 219 (44.51%) female and 32 (6.5%) nymph

    Conclusion: Studied area is important for production of livestock and dairy products. Annually, many livestock products are exported to other parts from this region; therefore, it is very important to identify the infection rate of tick-borne diseases as well as safety factors on livestock.



Case Report(s)

  • XML | PDF | downloads: 235 | views: 216 | pages: 750-754

     Fascioliasis is a foodborne zoonotic disease caused by the two parasite species Fasciola hepatica and F. gigantica. In spite of the presence of both species of Fasciola in the livestock, to our knowledge, to date, no cases of human F. gigantica infection have been reported in Iran officially. Here, we report such a case in a 25 yr old woman referred to The Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran in 2016. CT imaging and MRCP revealed an ill-defined lesion of segments of liver. Specific ELISA produced a positive result besides detecting egg of the parasite via stool exam. The identification of parasite species was performed by the DNA extracted from the eggs and sequencing ITS-1, in addition to comparison to GenBank retrieved sequences, using the BLAST search tool. The sample showed 100% identity with F. gigantica. She was treated for fasciolosis with a single dose of Egaten® 10 mg/kg with positive response. This is the first case of human fasciolosis due to F. gigantica reported in Iran.



Letter to the Editor