نشریه پژوهش در پزشکی
سال سی و یکم شماره 3 (پیاپی 123، پاییز 1386)

Despite many studies on the effect of saturated fat and cholesterol intake on serum lipids, data on the combined effect of these two dietary components on serum lipoprotein response is very limited.

In this study, a representative sample of 443 subjects, aged 18 years and over, were included. Dietary intake was assessed by means of two 24–hour dietary recall questionnaires. Height and weight were measured and BMI was calculated. Total cholesterol, triglycerides and high density lipoprotein cholesterol levels were measured and serum cholesterol was calculated. Cholesterol intake ≥300 mg/day was defined as high cholesterol intake, and saturated fat intake ≥7% of total energy was defined as high saturated fat intake. Individuals were categorized into 4 groups, based on cholesterol and saturated fat intake each of these was assessed for 2 levels of serum lipids, normal and high. Pearson's correlation coefficient was used to detect confounding variables. Two-Way ANOVA was used to determine both the main effect of each of the two factors on lipids and their combined effect as well.

Mean age of subjects was 40.1± 14.6 y. The main effect of cholesterol and saturated fat intake on energy intake was significant. Subjects in whom cholesterol and saturated fat intake was normal had significantly less energy and fat intake than those who had high cholesterol and saturated fat intake (p<0.01). Saturated fat intake was seen to have a significant main effect on serum total and HDL cholesterol levels. Subjects who had a normal saturated fat intake, had significantly less serum total and HDL cholesterol than those who had high saturated fat intake (p<0.01 and p<0.05, respectively). Adjusted for age, sex and BMI, the main effect of cholesterol intake on HDL cholesterol was significant (p=0.05). Mean serum HDL was lower in subjects who had normal cholesterol intake than in subjects who had high cholesterol intake.

The present study shows that cholesterol and saturated fat intake had no combined effect on serum LDL cholesterol level, whereas cholesterol intake per se did affect serum HDL cholesterol level.

The purpose of this clinical study was to assess the success of infra-inguinal revascularization in the treatment of lower limb ischemia in patients hospitalized with trauma.

Fifty seven consecutive patients admitted with trauma, during April 2000- March 2005, underwent bypass operations in the Shohada Hospital. Records of all patients were reviewed. Late control visits including clinical and color Doppler ultrasound examinations of arteries distal to the bypass were programmed for 41 patients. Primary, and secondary patency rates, and survival were determined.

Patients included 54 men (94.7%) and 3 women (5.3%) who underwent infrainguinal bypass with autologous saphenous vein. Primary patency rate was 89.5% and secondary patency rate was 97.3% with 44.5 months of follow up. Complication rate was 3.5% and amputation 10.5%. Mean transportation time was 22.7±17.8 hours. Limb salvage was done in 26.8% of patients with no mortality.

Infra-inguinal revascularization can be performed in damaged limbs due to trauma with high primary and secondary patency rates and low complication rate. Keywords: trauma, infra-inguinal bypass, limb ischemia, saphenous vein.

Asthma is the most prevalent chronic disease in the world. To quantify the national prevalence of asthma symptom, we conducted a systematic review and random effects meta-analysis.

After internet search for population-based estimates of Asthma prevalence in Iran, 19 papers were selected from 142 articles, dissertations and reports of research projects published between the years 1998-2003. All studies on children performed by ISAAC protocol were found. We entered the data from studies in children to NCSS software. We used funnel plot for publication bias.

In the 19 accepted studies on children under the age of 18 years, 61067 children had been checked by the ISAAC protocol. The lowest prevalence of asthma is 2.7% from Kerman and the highest prevalence is 35.4% from Tehran. Overall prevalence of asthma symptoms in children is 13.14%, (95% confidence interval 9.97-16.30), at the national level.

Based on this study the prevalence of asthma symptom in Iran is higher than international norms.

Acute Promyelocytic Leukemia, APL, belongs to the group of acute myeloid leukemias. It is distinguished from other types of leukemia by distinct cell morphology, immuno-phenotyping characteristics, coagulopathy and different treatment modalities. The aim of this study was evaluation of the effects of cytologic, clinical and biologic factors specially CD34 expression in determining prognosis in patients with APL.

In a descriptive retrospective analysis files of 60 patients with APL were reviewed and data statistically analyzed using SPSS soft ware with Chi Square and T- test.

Complete remission and disease free survival (DFS) had no significant correlation with age, sex, WBC, Hemoglobin level, platelet count, purpura, CD34 status, and percentage of blasts in the bone marrow. There was no statistically significant correlation between CD34 expression with morphology, age, sex, WBC, platelet count, percentage of BM blasts and purpura. Cases with CD34 expression had severe anemia, (Hemoglobin=5.8±1.08), in comparison with patients with CD34 negative APL, (p=0.02).

Results of our study were not concordant with the literature, as recognized prognostic factors had no significant effect on the prognosis of our patients therefore it is logical to believe that factors influencing the prognosis of APL in Iranian patients may be different. Failure in obtaining complete remission in all 4 patients with CD34+ APL indicates that presence of CD34+ may have been the cause of poor prognosis in these patients. Further studies are necessary to confirm this observation.

Klebsiella pneumoniae is one of the most important and prevalent bacterium isolated from clinical cases especially from hospitalized patients. Recent studies have focused on multiple drug resistant K.pneumoniae strains. In this survey, drug resistance in clinical isolates was studied with special reference to extended spectrum β-lactamase.

A total of 303 K.pneumoniae strains isolated from hospitalized patients were initially surveyed for drug resistance by disc diffusion method. The resistance of the isolated strains to different antibiotics was determined by E-test. β-lactamase production was tested with nitrocephin discs and extended spectrum β-lactamase assays were performed with double disc synergy tests.

From the total of 303 K.pneumoniae isolates tested, 62, (20.4%), showed multi drug resistance, (MDR). All of these MDR strains were positive for nitrocephin test, indicating β-lactamase production. Double disc synergy tests results showed production of extended spectrum β-lactamase in all MDR isolates.

Detection of 20.4% MDR strains, especially extended spectrum β-lactamase, from K. pneumoniae isolated from hospitalized patients, emphasizes the potential dangers of the widespread usage of extended spectrum cephalosporins. It also necessitates conduction of a wider study to determine the nationwide incidence of K. pneumoniae.

CD4 count is the most important indicator of the degree of immune deficiency in HIV-positive patients. The goal of this research was to study the relationship between CD4 count and psychological disorders in these patients.

In this cross-sectional study, subjects were studied from June 2004 for one year in Sina hospital in Kermanshah. HIV infection was confirmed with positive double ELISA and Western Blot, CD4 counts by flow-cytometery. SCL-90-R questionnaire was used for selection of patients. In the second stage diagnostic symptom checklist based on DSM-IV criteria was used for patients with unconfirmed diagnosis of psychological disorders. All data were then analyzed.

From 59 studied patients, 58 patients were males all being addicts with prison records. Mean age of patients was 34.26±7.4, (range 23 to 50), years. Mean CD4 count was 312±216 per micro liter. The incidence of psychological disorders was 62.7% multiple disorders 22%, mood disorder %22, anxiety disorder %8.5, psychotic disorder 5.1%, cognitive disorder 3.4%, and personality disorder 1.7%. The least CD4 count was found in single cognitive disorder (129cells/ul). There was a significant statistical relationship between cognitive disorder, (apart from it combination with other disorders), and CD4 count of lower than 200 per micro liter (p=0.021) and CD4 percent lower than 15 (p=0.032). Also, relation between single anxiety disorder and CD4 count of lower than 200 per micro liter was significant, (p=0.033). In addition, there was a significant relationship between pneumonia syndrome and mood disorder (p=0.009), and between soft tissue infection and psychotic disorder (p=0.017). Prison settlement of over 60 months was related to anxiety disorder (p=0.045).

In this research psychiatric disorder incidence was higher than other studies that could be due to the high rate of addiction and imprisonment. Relation between CD4 count with cognitive and anxiety disorders indicated that with the progression of HIV infection, there is an increase in the occurrence psychological disorders with social problems having additional adverse effects on the psychological status.

This study has been designed to evaluate the efficiency and coverage of the National Hypertension Prevention and Control program in predefined referral levels in Damavand district in Tehran.

In this household survey 14 out of 27 health centers in Damavand were selected randomly and questionnaires completed for 400 persons aged 30 years or older who were selected systematically, in proportion to the size of the targeted population of each village.

Coverage rate of screening program was 11.5% for men, 14.1% for women and 13% on the whole. Response rate to screening was 94 %. Coverage of second, third and fourth referral levels was zero. Coverage of screening program was too low for modeling service utilization.

The service has not been presented to the target population correctly and they were not aware of the service delivery. Program standards were not achieved completely. For program success, strict control is needed on the procedures of program implementation.

Vitiligo is an idiopathic and acquired disease characterized by de-pigmented areas of skin. The precise mechanism involved is not clear. Low levels of folic acid and vitamin B12 have been suggested to play a possible role in the pathogenesis of vitiligo. In this study we checked the serum level of folic acid and vitamin B12 in patients with vitiligo.

In this case-control study 50 patients with the mean age of 25.3±12 years and 50 normal controls with mean age of 31±12.4 years were evaluated. Radioimmunoassay was used to determine serum level of folic acid and vitamin B12. Patients with pernicious anemia and history of folic acid and vitamin B12 supplement therapy were excluded from this study.

Mean serum level of folic acid and vitamin B12 was 7.9±3.5 ng/ml and 320.5±183.6 pg/ml, respectively, in patients. The figures for controls were 301.4±13 pg/ml and 6.8±3.9 ng/ml.. According to t test this difference was not significant (p>0.05).

In this study no association was found between the serum level of folic acid and vitamin B12 in patients with vitiligo.

The aim of this study was to compare the attachment styles of persons with or without substance use disorders.

Two hundred and forty volunteers (120 patients, 120 controls) were included in this study. All participants were asked to complete Substance Use Disorders Questionnaire (SUDQ) and Adult Attachment Inventory (AAI). Analysis of the data involved both descriptive and inferential statistics including means, standard deviations, t-tests, Pearson's correlation coefficients, and regression analysis.

The results revealed a significant difference between attachment styles of the patients with substance, (opioid), use disorders and controls. Secure and insecure attachment styles had significant negative and positive correlations, respectively, with opioid dependency.

Attachment styles of patients with substance use disorders with opioid abuse are influenced by processes of family interactions, social control, affection regulation and self-efficacy.

This study was conducted with the aim of determining the frequency of mental disorders, (Depression, Anxiety, Aggression, somatization, and Interpersonal relation-ships), between substance users referred to two centers in Tehran affiliated to the Welfare and Rehabilitation Organization of Iran.

Study design was cross-sectional. A demographic questionnaire and SCL- 90-R checklist were utilized by researchers who used 5 scales from nine scales of the checklist for testing the psychological status of the patients. Subjects were selected from individuals who came to the centers for treatment and rehabilitation.

This research on 370 substance abusers indicated that mental disorders are present between most subjects regardless of age, education, length of dependency, kind of drug, and family history. Also x2 test suggested a significant difference in somatization with age, (p<0.03), and in Depression with the level of education, (p<0.06).

Results of this study suggest that there is an increased prevalence of psychiatric symptoms in younger users, low level of education, and subjects who have abused drugs for more than two years.

Organic solvents are widely used in different industries and occupations. They have a central role in production and use of paints. This study was carried out to evaluate the hepatic damage due to solvent exposure.

In this cross-sectional study 62 painters were selected as cases with at least one year exposure to solvents and 54 employees as controls with no exposure. Demographic and clinical information collected via questionnaire and physical examination and the results of liver function tests, (ALT, AST, ALP), were compared in the two groups.

The mean levels of ALT, AST, and ALP were not significantly different between cases and controls however the mean levels of ALT and AST in individuals with high exposure were significantly more elevated than in persons with low exposures, (subgroups of cases).

We concluded that routine hepatic enzyme tests are not suitable for early detection of hepatic damage in workers exposed to solvents and the use of more sensitive tests should be considered.

HDL-C measurement is important in cardiovascular diseases evaluation. Precipitation method is common procedure in this measurement, but direct method widely used nowadays. The aim of the present study was to compare the results of the two aforementioned techniques and their correlation.

During August 2006, serum HDL-C of 212 subjects (98 male, 114 female with the mean age of 39±20 year) referring for Tehran Lipid and Glucose Study were determined by direct and precipitation methods simultaneously.

The HDL-C levels of the direct and precipitation methods were 43.5±10.2 and 45.2±10.9mg/dl, respectively. Direct method had 3.9% higher value results (P=0.000) and two methods had good correlation (r=0.943). Intraassay coefficient variation (CV) of precipitation and direct method were 5.6% and 3.3%, respectively. Assay time of direct method was half of precipitation method and its cost was 3 folds higher.

The study revealed that the results of direct HDL-C method had good correlation with the precipitation method, its precision and speed was more acceptable. After moderating the price of direct method, it will be a good substitution for precipitating method.

Cyclooxygenase (COX) is the key enzyme required for the conversion of arachidonic acid to prostaglandins. Two cycloxygenase isoforms have been identified and are referred to as COX-1 and COX-2. Both enzymes are blocked by nonselective anti-inflammatory drugs (NSAID), such as indomethacin and ibuprofen. COX-1 is an enzyme normally found in tissues and is involved in physiological functions, while COX-2 is an acute phase reactant associated with inflammation. Recently, COX-2 has been found to be associated with hyperalgesia, angiogenesis, cancer and Alzheimers disease. The suggestion that COX-2 is causally linked to cancer offers a new approach to extending our knowledge about the neoplastic phenomenon and improving management of human malignant diseases.