Archives of Iranian Medicine
Volume:15 Issue: 9, Sep 2012

Short term randomized trials have shown the effectiveness of a fixed dose combination therapy (known as Polypill) on reducing blood pressure and serum cholesterol but the impact of Polypill on cardiovascular disease risk or mortality has not yet been directly investigated. Previous studies combined the effects of each component assuming a multiplicative joint risk model that may have led to overestimating the combined effects. We conducted an updated meta-analysis of randomized trials of anti-hypertensives, and aspirin. We used the estimated effect sizes applying a more conservative assumption to estimate the number of ischemic heart disease (IHD) and stroke deaths that could have been averted by Polypill in Iranians aged 55 years or older in 2006. We searched Medline and reviewed previous meta-analyses to select randomized trials on Angiotensin Converting Enzyme-inhibitors, thiazides, aspirin, and statins. We used a random-effects model to pool relative risks for each component and estimated the joint relative risks using multiplicative and additive assumptions for 4 combinations of Polypill components. We used age- and cause-specific mortality, separately by gender, and estimated the number of preventable deaths from IHD and stroke. Under the additive joint RR assumption, the standard Polypill formulation was estimated to prevent 28500 (95% CI: 21700, 34100) IHD deaths and 12700 (95% CI: 8800, 15900) stroke deaths. Removing aspirin from the combination decreased preventable IHD deaths by 15% under the additive assumption (5600 deaths) and by 21% under the multiplicative assumption (6800 deaths) and reduced preventable stroke deaths under both additive and multiplicative assumptions by 3% (300 deaths). There was no significant difference between Polypill combinations with anti-hypertensive agents in full-dose or half-dose. Polypill can prevent a large number of IHD and stroke deaths in Iran. The cost-effectiveness, feasibility, and acceptability of this prevention strategy remain to be investigated.

Studies on the association between legume intake and metabolic syndrome (MetS) are sparse. The objective of this study is to evaluate the association between legume intake, MetS, and its components. This study was conducted on 80 subjects (48% female) with MetS as cases and 160 age and gender-matched healthy controls. Anthropometric measures, blood pressure, fasting blood glucose, and lipid profiles were evaluated by standard methods. Dietary data were collected using a food frequency questionnaire (FFQ) and legume intake was determined. MetS was defined according to the definition of the Adult Treatment Panel III. The mean (SD) intake of legumes was 1.4 (0.9) servings/week for cases and 2.3 (1.1) servings/week for control subjects (P < 0.05). After adjustment for potential confounders, decreases in mean systolic blood pressure, fasting blood glucose, and increase in HDL cholesterol levels were observed across increasing quartile categories of legume intake. After adjustments for life style and food groups, subjects in the highest quartile of legume intake had lower odds of having MetS compared with those in the lowest quartile [odds ratio (OR): 0.25; 95% CI: 0.11 – 0.64, P < 0.05], an association that weakened after adjustment for body mass index (BMI), but remained significant (OR: 0.28; 95% CI: 0.12 – 0.81, P < 0.05). Legume intake is inversely associated with the risk of having MetS and some of its components.

This study aimed to apply the conceptual framework of the theory of planned behavior (TPB) to explain fish consumption in a sample of people who lived in Bandar Abbass, Iran. We investigated the role of three traditional constructs of TPB that included attitude, social norms, and perceived behavioral control in an effort to characterize the intention to consume fish as well as the behavioral trends that characterize fish consumption. Data were derived from a cross-sectional sample of 321 subjects. Alpha coefficient correlation and linear regression analysis were applied to test the relationships between constructs. The predictors of fish consumption frequency were also evaluated. Multiple regression analysis revealed that attitude, subjective norms, and perceived behavioral control significantly predicted intention to eat fish (R2 = 0.54, F = 128.4, P < 0.001). Multiple regression analysis for the intention to eat fish and perceived behavioral control revealed that both factors significantly predicted fish consumption frequency (R2 = 0.58, F = 223.1, P < 0.001).The results indicated that the models fit well with the data. Attitude, subjective norms, and perceived behavioral control all had significant positive impacts on behavioral intention. Moreover, both intention and perceived behavioral control could be used to predict the frequency of fish consumption.

This study was conducted to determine the effect of fish oil (FO) supplements on high density lipoprotein cholesterol (HDL-C), apolipoprotein-AI (Apo-AI), malondialdehyde (MDA), arylesterase (Aryl), and paraoxonase-1 (PON1) activity in female patients with rheumatoid arthritis (RA). A total of 90 RA patients were randomly allocated into two groups that were treated with one FO pearl (1 gr) daily or placebo for three months in addition to conventional treatment. HDL-C, Apo-AI, and MDA levels as well as PON1 and Aryl activities were measured before and after treatment. Independent t-test was used to match basal parameters of case and control groups. Paired t-test was used to assess significance of the differences. Correlation was evaluated by Pearson’s test and the statistical significance was set at P < 0.05. No significant differences were noted between FO and placebo patients with regards to age, disease duration, post-menopausal status, conventional therapy, body mass index (BMI), and numbers of swollen and tender joints at the beginning of the study. There were 83 patients who completed the three-month follow up. Serum levels of HDL-C (P = 0.018), Apo-AI (P = 0.165), Aryl (P = 0.026), and PON1 (P = 0.049) activity increased, whereas MDA levels decreased significantly with FO supplementation (P = 0.077). Significant correlations between increased PON1 activity and both HDL-C (P = 0.007, r = 0.419) and Apo-AI (P < 0.001, r = 0.742) concentrations as well as between HDL-C and Apo AI levels (P = 0.01, r = 0.403) were found. According to the results of this study, FO could increase serum HDL-C and PON1 levels and Aryl activity in female patients with RA.

Impaired wound healing in ischemic tissues such as skin flaps resulting from inefficient perfusion is one major cause of complications in plastic surgery. In present experimental study, we investigated the effects of fibroblast growth factor-2 (FGF-2 or bFGF) and erythropoietin (EPO) in prevention of skin flap necrosis in rats. 30 adult albino rats were randomized into 3 groups: in control group, normal saline solution; in EPO group, erythropoietin (100U/kg/day); and in FGF-2 group, fibroblast growth factor-2 (2.5µg/day) were injected subcutaneously in 3 daily consecutive doses in the designated flap areas before creating 4:1 random pattern skin flaps on the dorsum of animals. Areas of ischemic (SI) and necrotic (SN) zones were measured and compared in all groups one week after the flap creations. The necrotic zone (SN), as well as the ratio of the necrotic zone to the total discolored zone (SN/[SI+SN]) were substantially larger in the control group (41%±7%, 90%±6%) compared to the EPO (20%±2%, 42%±4%) and the FGF-2 (8%±2%, 19%±3%) groups (p<0.001). The differences in these values were also meaningful between the EPO and FGF-2 groups (p<0.001).Vascular density in ischemic area of the control group was less than those in the EPO and the FGF-2 groups; however, the differences were not statistically significant between any of the groups (p>0.05). Local administration of erythropoietin or fibroblast growth factor-2 in skin flaps could remarkably increase tissue viability and accelerate the wound healing process. However, the therapeutic effect of fibroblast growth factor-2 in preventing the necrotic event in ischemic zones of skin flaps is much more considerable than that of erythropoietin.

Contribution of neuroinflammation and epilepsy in the mature brain has elicited contradictory results with either excitatory or inhibitory effects. The amygdala is one of the main parts of the limbic system susceptible to insults that lead to neuroinflammation and epilepsy. This study evaluates the effect of chronic inflammation of the rat amygdala induced by lipopolysaccharide (LPS) on kindling epileptogenesis. LPS (5µg/rat) was infused once daily into the basolateral amygdala (BLA) of adult rats. Daily electrical stimulation (150 – 300 µA, 100 Hz, monophasic square wave stimulus of 1 msec per wave, 2 sec duration) was delivered into BLA 30 min after LPS injections until the animals became fully kindled. LPS had no significant effect on the development of focal and generalized seizures. The type of neural system exposed to LPS and its specific electrophysiological properties seems to ascertain the final excitatory or inhibitory outcome.

The current study attempted to investigate factors associated with attention deficit hyperactivity disorder (ADHD) in children without co-morbidities. In this case-control study, 164 ADHD children who attended the Child and Adolescent Psychiatric Clinics of Tabriz University of Medical Sciences, Iran were compared with 166 normal children selected in a random-cluster method from primary and secondary schools. Clinical interviews based on DSM–IV–TR using K-SADS were used to diagnose ADHD cases and to select the control group. Participants were matched for age. We used chi-square and binary logistic regression for data analysis. Among the associated factors with ADHD were gender and maternal employment. Boys (OR 0.54; 95% confidence interval: 0.34 – 0.86) and those children with working mothers (OR 0.16: 95% confidence interval: 0.06 – 0.86) suffered more from ADHD. The birth season, family size, birth order, and parental kinship were not among risk factors for ADHD.The results of the study show that maternal employment and male gender are among the associated risk factors for ADHD.

This study was carried out to identify molecular and hematological features of α- globin chain variants and to evaluate their effects on the clinical and hematological characteristics in Iranian individuals suspected of having thalassemia trait. Analysis of red blood cell indices, hemoglobin (Hb) analysis and genomic DNA isolation were carried out according to standard methods. For identifying the α-thalassemia (α-thal)genotype, investigation of common Mediterraneana-globin gene deletions (-a3.7, -a4.2 -a20.5 and --MED) was performed by Gap-PCR.To characterize chain variants the entire α1 and α2genes that spanned from the promoter region to the poly A tail were amplified and directly sequenced. In this study, 19 members of 17 unrelated families showed α-chain variants. Among these cases ten α-chain variantsthat included Hb Setif, Hb Constant Spring (Hb CS), Hb Handsworth, Hb Icaria, Hb Evanston, Hb Val de Marne, Hb Utrecht, Hb Savaria, Hb Adana, and Hb Dartmouth were identified. The hematological profile and molecular basis of these ten α-chain variants and the phenotypic consequences of their interactions were discussed. The knowledge of the spectrum of α-globin variants present in the Iranian population is essential for the molecular diagnosis and prevention of hemoglobinopathies.

This study determined the incidence, characteristics, risk factors, and outcomes of ventilator-associated pneumonia (VAP) in newborns hospitalized in a Neonatal Intensive Care Unit (NICU) in Tehran, Iran. A prospective cohort study was carried out in the NICU of Mahdieh Hospital over a period of one year, from December 2008 to November 2009, on all neonates mechanically ventilated for more than 48 hours. VAP was diagnosed in accordance with the CDC definition of nosocomial pneumonias for patients younger than 12 months. Risk factors relevant to the development of VAP were studied. Multiple logistic and Cox regression analysis were performed to determine independent predictors for VAP and survival rate, respectively. There were 81 neonates enrolled. VAP occurred in 14 (17.3%), at a rate of 11.6/1000 days on the ventilator. Gram negative bacteria were the predominant etiologic agents. The most common bacterial isolates from the endotracheal aspirate were E. coli (21.4%), Klebsiella (21.4%), and Pseudomonas (14.1%). The only VAP predictor was sputum [odds ratio (OR) = 5.11, P = 0.02]. Mortality rate for VAP was 2/14 (14.3%). Duration of mechanical ventilation [hazard ratio (HR) = 0.96, P = 0.01], birth weight (HR = 0.81, P < 0.001), and purulent tracheal aspirate (HR = 0.25, P < 0.006) were independent predictors of overall survival. VAP occurs at a significant rate in mechanically ventilated newborns. Additional studies are needed to accurately determine the incidence and risk factors in order to develop effective preventive and therapeutic protocols.

Cervical cancer is one of the most common tumors in women. One of its risk factors is direct contact with viruses, in particular human papillomavirus (HPV). Recent studies have shown a prevalence of 2%-35% for HPV in cases with bladder cancer. In addition, some malignancies of the urogenital organs in males may promote the probability of cervical cancer in their spouses. In this study, the relationship between cervical dysplasia in women and evidence of HPV infection in tissue specimens obtained from their spouses’ bladders has been investigated. This cross-sectional study was conducted on 82 male patients with bladder tumors and their spouses between February 2004 and February 2007 in Tehran. We gathered data related to the histopathology of the transitional cell carcinoma (TCC) in men and Pap smear tests of their spouses. Tissue specimens of patients with bladder TCC were analyzed for HPV infection using polymerase chain reaction (PCR). HPV-positive specimens were tested for subtypes 16 and 18. In 24 (29.3%) men, bladder tumor samples were positive for HPV infection. Of these, we found HPV-18 infection in 9 (37.5%), while 3 (12.5%) were infected with HPV-16. In the spouses of those men with HPV-infected bladder tumors, 4 (4.9%) cases had cellular dysplasia noted on their Pap smear tests. We found no dysplasia in those women whose husbands had bladder TCC, but no HPV infection (P = 0.006). It is possible to decrease the incidence of bladder TCC in men and cervical cancer in women through public education regarding the methods of transmission and avoidance of risky sexual behaviors.

Effect modification, also known as interaction or heterogeneity of effect, is an important concept in epidemiology. This article reviews the definition and types of effect modification, methods to detect effect modification, the reasons for observing effect modification in epidemiologic studies, the importance of choice of model in finding effect modifiers, and effect modifications that are important to public health.

Head injury is a common occurrence in motor vehicle accidents. There are numerous causes for cranial nerve injury that include head trauma or other lesions. Few studies regarding cranial nerve injury following mild head trauma (GCS: 14 – 15) exist in the literature. The oculomotor nerve is a somatic and visceral motor nerve. When it is completely injured the result is ptosis, pupils that are non-reactive to light and a lack of eye movement. We report the case of a completely isolated oculomotor nerve palsy associated with minor head injury.