Iranian Journal of Public Health
Volume:38 Issue: 2, Summer 2009

Ultrasonic technology as an innovative technology may be used for water and wastewater treatment for pollution removal. This technology acts as an advanced oxidation process. Application of this technology leads to the decomposition of many com plex organic compounds to much simpler compounds during physical and chemical compounds during cavitation proc ess. In this article review, some applications of this valuable technology are presented.

Methyl tert-butyl ether (MTBE) has been commercially used as an octane enhancer to replace tetraethyl lead in gasoline since 1979. The high mobility, water solubility, and resistance to natural attenuation associated with MTBE may re sult in contamination of ground and surface waters. In this investigation the degradation of aqueous MTBE at relatively high concentrations was studied by UV-vis/TiO2/O2 photocatalytic process. The effect of important operational parameters such as pH, oxygen flow, catalyst loading, and irradiation time were also studied. Concentration of MTBE and intermediates such as tert-butyl formate (TBF) and tert-butyl alcohol (TBA) were meas ured using a gas chromatograph equipped with flam ionization detector and combined with headspace sampler. The time required for complete degradation increased from 15 to 150 min, when the initial concentration was in creased from 10 to 500 mg/L. The first order rate constant for degradation of MTBE from the hydroxyl radical was esti mated to be 0.266 to 0.033 min-1 as the concentration increased from 10 to 500 mg/L. Study on the overall mineralization moni tored by total organic carbon (TOC) analysis showed that in the initial concentration of 100 mg/L MTBE, complete min eralization was obtained after 110 min under UV-vis/TiO2/O2 photocatalytic process. The data presented in this paper clearly indicate that UV/TiO2/O2 advanced oxidation process provides an effi cient treatment alternative for the remediation of MTBE contaminated water

To evaluate VDR gene variation and its interaction with immune regulatory molecules in osteoporosis. Totally 205 pre and postmenopausal women were recruited in the study. After an overnight fast, peripheral blood was taken and centrifuged to sprat serum for measurement of serum parathyroid hormone, 25 hydroxyvitamin D, osteocal cin and cross laps. The FokI polymorphism in exon 2 of the VDR gene was detected by PCR-RFLP. Expression of osteopro tegrin, vitamin D receptor (VDR) and β-actin genes were quantified by quantitative real-time reverse transcriptase. To design the experimental model we randomly selected five participants of each genotype groups. PBMC were cultured and induced with vitamin D. At several times, cells were harvested and total RNA was extracted. Then expression of target genes evaluated by real time PCR. The frequencies of Ff, FF and ff genotypes were 34.2%, 56.5% and 9.2%. The mean of bone mineral density in FF genotype was higher than other genotypes. Also in this genotype, mean of serum inflammatory cytokines was lower than other genotypes. The expressions of the VDR and osteoprotegrin were up regulated by 1, 25(OH)2D3 in PBMC from participants with FF genotype. PBMC from healthy control comparison to osteoporotic patients had a clearly better response to vitamin D3 incubation. Inflammation may important role in osteoporosis whereas osteoporotic patients have elevated pro-inflamma tory profile. This cytokine profile and gene expressions of VDR and Osteoprotegrin were different in VDR genotype groups.

Oral lichen planus (OLP) is a relatively common chronic inflammatory muco-cutaneous disease classified among the potentially malignant lesions of oral mucosa. In this study we evaluated tissue expression of p53، ki-67 in OLP com pared to normal oral mucosa. Specimens (formalin-fixed and paraffin- embedded) of 44 lesions of OLP and 30 controls referred to immuno histochem istry (IHC) analysis for p53 and ki-67. Results of immunohistochemistry were statistically evaluated by means of Kolmogorov- Smirnov, Kruskal- Wallis and t-test. The level of statistical significance was established at P< 0. 05. This study included 44 patients with OLP (27 females and 17 males) and 30 subjects as control group (18 females and 12 males). The mean expression of p53 in patients with OLP was greater than subjects in control group. The mean expres sion of ki- 67 in patients with OLP was more than people in control group. These differences were statistically signifi cant (P= 0. 001). Since p53 and ki-67 extensively accepted as important biomarkers in diagnosis, prognosis and treatment of malig nant and premalignant lesions, therefore high degree of presence of these biomarkers in chronic premalignant lesion like OLP can be a great helpful in its prognosis and suggested treatments.

Characterization of Leishmania parasites is necessary for epidemiological objectives such as documenting the distri bution of predominant species and designing appropriate control measures. In this study, we aimed to identify Leishma nia species isolated from cutaneous leishmaniasis (CL) patients, using RAPD-PCR method. This descriptive, cross-sectional study was designed against 20 Leishmania spp. which were confirmed by para si tological examination, isolated from 30 suspected cutaneous leishmaniasis patients, referred to Health Centers of Kerman shah Province from August 2006 to December 2007. All desirable samples were characterized by RAPD-PCR method using five selected oligoprimers (AB1-O7, A4, 327, 329 and M13). Electrophoresis patterns from each isolate were com pared with reference strains of L. tropica, L. major and L. infantum. Eighty nine percent and 11% of isolates were similar to L. major and L. tropica reference strain, respectively. Five of the isolates were identified as L. major using RAPD-PCR, induce ulcers at the base tail of Balb/c mice, 4-6 months after inocula tion. L. major is dominant in the studied areas and it seems that some parts of the Kermanshah Province to be pro ba bly considered as zoonotic cutaneous leishmaniasis areas in the middle west of Iran.

To assess the frequency and type of adverse events after influenza vaccination in Iranian adults. Health care workers in 7 medical centers received the influenza vaccine from October 2006 to February 2007 and fol lowed by phone regarding symptoms experienced after vaccination. Of 897 adults who participated in the study, local and systemic reactions were reported by 187 (20.8%) and 198 (22.1%) persons, respectively. The most common local reaction was pain (20.2%), while myalgia (15.8%) was the most com mon systemic reaction. One case of Guillain-barre syndrome was reported. Inactivated influenza vaccine administration did not result in potential adverse events in healthy adults.

Classic phenylketonuria (PKU) is a rare metabolic disorder that results from a deficiency of a liver enzyme known as phenylalanine hydroxylase (PAH). In this study, we researched about PKU epidemiological factors and health quality of patients after the neonatal screening program. Neonatal screening for PKU was conducted by one neonatal screening center in Fars Province, in Shiraz Paramedical University. All Fars infants must refer only to this center, in which a heel prick blood sample of each infant was collected at 72 hours postnatal on to standard filter paper and asked questions from the children''s parent''s and the doctor examined the patients receiving phenylalanine- free milk through examining the children''s development. PKU was screened by Fluorometric method. Totally of 70477 newborns screened for PKU, 15- cases of PKU detected with an incidence of 1:4698. In "Eghlid", that is a city in Fars Province. The prevalence of the disease is 1:382 of newly born babies. The frequency of familial marriage in these children''s parents is 86.6%. Twenty nine percent of them were observed among those who had married their close relatives. Mean rate of normal development in PKU patients was 95%. Consanguineous marriage is a major cause in that pattern particular in Iranian. The treatment of PKU after newborn screening is used. With special diet in above of 90% newborn is satisfactory. Now screening should be executed for all of family that they have familial history of PKU in Iran.

This study has been conducted on workers from several workplaces where materials containing lead are used during December 2006-April 2007 in Eskişehir, a city of the Middle Anatolian Region of Turkey. The study and control groups were occured with 403, and 97 men, respectively. After each interview with the individuals, their blood pressures (BP) and complete blood counts (CBC) were measured. The blood lead level (BLL) of 10 μg/dL was accepted as cut off level for high BLL. In statistical analyses, Chi-square test (x2), Fisher’s exact test, Student t-test, Kolmogorov-Smirnov Z test, and Logistic regression analysis were applied. The mean age was 35.55±9.00 yr (min=18, max= 54) in study group. The prevalence of high BLL was 10.2% (n= 41) in study group. The working on smeltery, and the working on polyvynil chloride product, and history of lead poisoning are important risk factors for high BLL (for each one P< 0.05). This study indicated several precautions and steps to be taken for better protection from lead poisoning: considering workplace medicine more seriously and particularly planning special health programs in order to raise awareness among workers for using protective gear/wear and applying routine hygienic habits, and improving the preventive measures for workplaces, and providing technical equipment for routine MAC measurements in workplaces, and increasing the legal liability and sanctions.

Reactive oxygen species (ROS) have important role in the etiology and pathogenesis of Rheumatoid Arthritis (RA). We investigated the effect of conjugated linoleic acids (CLAs) and vitamin E on lipid peroxidation. In a randomized, double-blind placebo, controlled, clinical trial 87 patients with active RA were enrolled. They were divided into 4 groups, received one of the following daily supplement for 3 months; 1- group C: 2.5gr CLA, that con tained 2 gr 50:50 mix of cis 9-trans11 and trans 10-cis 12 CLAs, 2- group E: 400mg Vitamin E, 3- group CE: CLAs plus vita min E, 4- group P: placebo. After supplementation Glutathione peroxidase (GSH-Px) level increased in C, E and CE groups, CE group had lower GSH-Px than P group(P≤ 0.05). Glutathione reductase (GR) increased in CE, C and P groups. Catalase increased in all groups, but enhancement was significant in C and CE. Superoxide dismutase (SOD) decreased in E and C (P≤ 0.05). Catalase and SOD did not show signifi cant differences between groups. Malondialdehyde (MDA) decreased significantly in all groups but this decrease was only significant in CE in comparison with other groups. CLAs might be useful in reducing oxidative stress in RA

Epidemiologic aspects of oral and pharyngeal cancers in Iran have not been studied adequately. We evaluated age-adjusted incidence rates by sex using pathological confirmed cases between 1991 and 2002 in Kerman Province, south east ern Iran. The information of cases was collected actively from all of the 18 histopathology departments around the prov ince. The standardize risks were estimated using standard world population and the risk ratio for age and sex were estimated us ing negative binomial model. The total number of newly diagnosed malignant oral and pharyngeal cancers was 334, represented 3.1% of all newly diagnosed cancers. The age-adjusted incidence rate for oropharyngeal cancers was 2.21 cases per 100 000 popula tions per year. The results suggested that those age 40 and over were 18.1 times more likely to develop oral and pharyngeal can cer than the younger group. The risk of developing oral and pharyngeal cancers was 1.75 times more common in males than females. This study showed that the overall incidence of oral and pharyngeal cancers in Kerman Province was lower than that in most parts of the world. The lower incidence might be due to behavioral differences such as low consumption of alco hol, chewing tobacco, and spicy foods.

To asses the status of two representative genes of cag PAI i.e cagA and cagE of Helicobacter pylori strains infecting Iranian patients suffered from various clinical outcomes using one-step PCR. A total of 120 H. pylori infected patients including non–ulcer dyspepsia, NUD (n=81), peptic ulcer disease, PUD (n=17), and gastric carcinoma, GC (n= 22) referred for endoscopy or gastric resection to AmirAlam Hospital or Cancer Institute from 2005 to 2008 were assessed. The status of cagA and cagE genes was determined by gene specific PCR. 84.2% and 90.8% of the tested strains were positive for cagA and cage, respectively. 81.7% strains were positive for both cagA and cagE genes, whereas 8 (6.7%) were found double negative. The prevalence of cagA in GC patients (100%) was slightly higher than PUD patients (94.1%). All of GC cases were infected with cagA-positive strains. The same distribution pattern was indicated for cagE gene in GC and PUD patients. The cagA-positive strains were significantly associated with GC as compared with NUD (P< 0.05) but this association did not gain statistical significance when cagE gene was assessed. The concurrent detection of cagA/cagE genes allowed rapid and specific clarification of cag PAI status. The strains with cagA/cagE genotype are predominant in Iran regardless of clinical outcome and create a distinct cluster pattern from those in the West and similar to those of East Asian countries. The current study also demonstrated that cagE gene can be explored as a better indication of cag-PAI in Iranian H. pylori strains.

Malassezia are dimorphic, lipid-dependent yeasts, which are responsible for causing several cutaneous and sys temic conditions. Although cyclophilins (CyPs) are highly conserved cytosolic proteins that catalyze the peptidyl-prolyl cis-trans isomerazation reaction before protein folding process, it has been suggestive of an allergen in a few numbers of fungi such as Aspergillus fumigatus and Malassezia species. Allergenic cyclophilins are IgE-binding components, which have been characterized in other species of Malassezia; and are considered as Mala s 6 in Malassezia sympodialis. In the pre sent study we tried to identify the molecular characterization of cyclophilin gene in M. furfur. Pairs of oligonucleotide primers were designed from highly conserved regions of the gene counterparts in other fungi. The primers were then applied to amplify the primer-specific DNA fragment. Afterward, PCR product fragments were sequenced to be used in further analysis. About 573 nucleotides, encoding a polypeptide of 190 amino acids, have been sequenced. Sequence comparison was performed in Gene Bank, both for the nucleotides and their deduced amino acid sequence. It revealed a significant homol ogy with cyclophilin genes and proteins of other eukaryotic cells. The amino acid sequence of the encoded protein was about 86% identical to the sequence of cyclophilin protein from other fungi. The molecular characterization of cyclophilin gene may open the way to disclosure of the functional char acteris tics of cyclophilin and is a fundamental step for understanding the molecular basis of its pathogenesis in AEDS dis ease.

Hepatitis B infection is a major public health problem worldwide. Dental students who are frequently in contact with body fluids like blood and saliva are still at high risk for HBV exposure. The aim of this study was to evaluate the effectiveness of HBV vaccine and personal factors associated with serologic evidence of the immune response. A descriptive-cross sectional study was carried out using data from Hamadan dental school students that received just three doses of HBV vaccine. The serum sample of 86 dental clinical students were examined in order to determine hepatitis B surface antigen and the level of anti-HBs using IEMA method. Logistic regression models were used to assess the relationship of vaccine response to the variables Sex, age weight, smoking status and the time lasting from the third dose of vaccine injection. Ninety-three percent had positive anti-HBs response and 7% were non-responders. No one showed HBsAg. Vaccine response was most strongly associated with age, smoking status, sex and weight. The time lasting from the third dose was unrelated to vaccine response. Clinical dental students had desirable immune response to the HBV vaccine nevertheless recommended num ber of doses, standard protocol and early vaccination are critical to adequate protection against hepatitis infection among all health care workers, in particular dental students and dentists who are often exposed to blood and other body fluids.

The Pabon Lasso model was applied to assess the performance of six State-run hospitals in the province of Kohgilooyeh & Boyer-Ahmad, to produce information that used by policy makers in their attempt to make the health care sys tem more productive This cross-sectional study involved all the six public hospitals in the province, with 607 registered beds. Data collec tion accomplished by the use of two ad hoc questionnaires that dealt with both general information and admission data from various hospital wards. The statistical software SPSS-13 used to derive three basic performance indicators, namely aver age length of stay, bed occupancy rate and bed turnover, which analyzed in Pabon Lasso model. The overall average length of stay, bed occupancy and bed turnover rates were 2.99 days, 62.78% and 76.73 respec tively. Two hospitals were in Zone III of the model, indicating a satisfactory level of efficiency. Three hospitals demon strated inefficiency and underutilization of resources by falling into Zone I. one hospital placed in Zone IV. The best approach to address the existing inefficiencies would lie in stopping the expansion of the current facili ties (e.g. not adding any more beds). As any further expansion will only serve to make hospitals more inefficient. Fu ture research should focus on why the performance is not at a desirable level and how the situation can be improved.

Studies show that about 90% of accidents occur because of unsafe behavior and human errors. Even if workers do not have the right knowledge, attitude and behavior toward safety measures in a safe workplace, all efforts for an accident-free workplace will be in vain. This study aims to determine the level of knowledge, attitude and behavior of workers toward occupational health and safety. This descriptive cross-sectional study was carried out on workers in Mahshahr Razy Petrochemical Complexm Ahwaz, Iran. A sample size of 210 was randomly selected. Data collection tool was a researcher-made questionnaire. Ques tionnaire’s validity was gained by content-validity and its reliability was validated by Kronbach’s alpha. Data was analyzed using SPSS 13. Mean age of workers was 31.1 years. The mean of their knowledge, attitude and behavior was reported 26.02, 153.18 and 36, respectively. 52.9% of workers had low, 36.7% moderate and 10.5% high level of knowledge. In addition, 75.7% of the subjects had a positive attitude towards occupational health and safety; 30% of workers had low safety behavior and 70% had safe behavior. The mean of knowledge grade shows a significant relationship with education level. A same relationship was reported for the mean of attitudes and behavior with age. Managers should design and implement educational interventions to promote knowledge, attitude and safe behaviors of workers.

Resistance patterns among nosocomial bacterial pathogens in hospitals may vary widely from country to coun try at any given point and within the same country over time. Acinetobacter baumannii is one of the most important bacte rium causes hospital acquired infections. Therefore, surveillance of antibiotic resistance of A. baumannii is necessary, espe cially in our country which there is no have much data in this field. In a prospective study, strain comprised of a total of 191 recent clinical isolates selected consecutively from clini cal infections of separate patients from three University hospitals in Tehran. Minimum inhibitory concentration (MIC) of these organisms for imipenem, ciprofloxacin and ceftazidime was determined using E test method according to CLSI guide line. Also, MIC50 and MIC90 percent was calculated for each of these antibiotics. The percentages of Acinetobacter baumannii isolates susceptible to ciprofloxacin and ceftazidime by E test were 55.5% and 44.5%, respectively. The percentage of bacterium susceptible to imipenem by E test was 72.8%. MIC50 and MIC90 of imipenem in E test were 1.5 and >32, respectively. High antimicrobial resistance against A. baumannii species has been seen in Iran; therefore, it is necessary to imple ment some approaches for prevention of bacterial spread.

Urinary tract infection (UTI) is considered as the most common bacterial infectious disease seen among the pediatric patients. The aim of this study was to investigate the prevalence and antimicrobial susceptibility of bacterial uropathogens isolated from the pediatric patients with urinary tract infections. This descriptive study was conducted in Children Medial Center, Tehran, Iran from March 2006 to Feb 2007. Clean-catch midstream urine specimens were obtained from the patients and cultured on the appropriate bacteriological media. Bacterial isolates were identified by standard biochemical and serological tests. Antimicrobial susceptibility testing was performed according to CLSI guidelines. From 14199 urine specimens, 16.2% had positive results for bacterial cultures. Nine hundred twenty one strains were identified as Escherichia coli; 412 as Klebsiella spp., 285 as Coagulase negative Staphylocococci, 202 as Enterococcus spp., 158 as Pseudomonas spp., and 83 as Staphylococcus aureus. E. coli isolates showed high resistance to carbenicillin (68%), ampicillin (96%), trimethoprim-sulfomethoxazol (70%) and kanamycin (65%). More than 30% of isolates of Klebsiella spp., Pseudomonas spp. and Enterobacter spp. have shown high degree of resistance to commonly used antibiotics. Our findings reinforce the need for ongoing investigation to show trends in antibiotic resistance, which can help to prescribing of antibiotics in clinics.

Health economists look towards health care sector as a market whereby there is a distinct demand and supply phenomenon exists. Dearth of regulation of the doctors’ practices lead to inappropriate and unjustifiable demand for health care among the patients. In developing and under-developed countries, this adverse practice may push a poor family into a vicious circle of poverty and illness, especially where out of pocket expenditure on health is too high. Unnecessary prescriptions, pro longed treatments and unjustified user fee grossly deprive the patient’s family financially. In developed countries, the flourishing health care technology and sophisticated laboratory diagnostics could incur significant expenditure which is sometimes even not covered under the insurance. State is the custodian of health care in any country; therefore, vigilant regulation of the health care providers may curb the supplier induced demand through strict laws and policies.

This paper presents a case-report of cutaneous actinomycosis due to Actinomyces viscosus in a 22 year old man, hospital staff from Tehran with multiple fistulous tracts in his right hand and a history of skin injury due to thorn of plant. Diagnosis was based on the observation of gram positive coccoid, diphtheroid and long branching filaments in direct examination of pus from fistulous tracts and isolation of microorganism in thioglycolate and Brain Heart Infusion (BHI) agar media in an aerobic conditions and some physiologic tests. Treatment of lesion was down with doxycyclin and penicillin 3 months and healing was acquired.