مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و ششم شماره 10 (پیاپی 214، دی 1397)

Pregnancy as a natural event leads to changes in various aspects of physiology, psychology, and social life. The adoption of a health promoting lifestyle is an important strategy for achieving the desired outcomes of pregnancy and is important on the future health of mother and child. The aim of this study was to assess the various aspects of health promotion behaviors during pregnancy. The data was obtained with advanced search in the Iranmedex, Magiran, Scientific Information Database (SID), IranDoc, PubMed, Google Scholar, Web of Science and Scopus databases. Articles containing full text were collected using the proper keywords for Persian articles and their equivalent in Mesh included “Health promotion" OR "Behavior health "OR “Health Promoting Lifestyle” AND pregnancy for English articles with a time limitation of 2010 to 2017. At first 3247 articles obtained after reviewing and evaluation of the references, 4 Persian and 25 English articles with observational and qualitative design were included. A review of studies showed that finding a way to pass pregnancy safely is the most important concern for mothers. Pregnant women do some actions to reach favorable outcomes and they have a high incentive to adopt health behaviors during pregnancy due to fear of fetal health, but there is some obstacle to adopt health behaviors including individual factors like that lack of time and inadequate information about pregnancy or health-related functions and social factors including health system problems and cultural factors. In addition age, level of education, individual’s beliefs and factors associated with pregnancy such as high-risk pregnancy and environmental factors such as social support and health system performance play an important role in the adoption of health behaviors. In order to increase the potential of pregnant women to adopt healthy behaviors, changing the health system approach and paying attention to social determinants of health, in order to carry out the necessary interventions, it is recommended to conduct qualitative studies and appropriate design for deep study of the subject in the cultural background.

Hookah smoking has been growing among people because consumers believe that smoking in the form of hookahs has lesser health effects than cigarettes. However, recent reports showed that water pipe smoking (WSP) increased heart rate, blood pressure, impaired pulmonary function and carbon monoxide intoxication. Chronic bronchitis, emphysema and coronary artery disease are serious problems of long-term use of this kind of smoking. Lung, gastric and esophageal cancers are associated with WPS, as well as periodontal disease, and obstetrical complications. Hence purpose of this study was to survey the relationship between lung cancer and tobacco consumption in the form of hookah through meta-analysis. In this meta-analysis study we conducted an electronically search in databases PubMed, MEDLINE and EMBASE to find relevant articles regarding the adverse effects of hookah smoking, using the terms ‘water pipe’ and its synonyms (hookah, shisha, goza, narghileh, arghileh and hubble-bubble) in various spellings in Iran University of Medical Sciences (IUMS), Tehran, Iran from January to May 2017. All articles including Cohort and case-control studies published between 1980 and 2017 and conducted in the world were included without restriction regarding publication language. The cross-sectional studies, case reports, conference abstracts, reviews and studies not conducted on humans were excluded. The article selection process and data extraction were performed by two independent investigators. The articles were evaluated using odds ratios, heterogeneity and distribution models. In this study, 120 articles related to the effect of hookah smoke on health were found. Of these articles, there were 9 articles related to the effect of hookah smoke on lung cancer. The results showed that hookah smoking could increases the risk of lung cancer with a chance ratio of 3.72 and a confidence interval of 4.85-2.60. Heterogeneity and distribution were not observed among selected articles. There is accumulating evidence about the association of water pipe tobacco smoking with of lung cancer, which increases the risk of lung cancer due to water pipe tobacco smoking consumption.

Sacrococcygeal pilonidal disease (PD) is prevalent in the young adults. The cause of PD is unclear, and there are different surgical procedures for the treatment. The Pilonidal sinus disease is an unpleasant, chronic relapsing condition that is difficult to cure. There is a wide variety of surgical treatments with sub-optimal results for it. The ideal treatment for the pilonidal sinus disease has yet to be defined. There are many surgical approaches described in the literature. In this study, the long-term outcomes of four current surgical methods for PD were evaluated and compared. We aimed to assess recurrence, satisfaction, complications rate and wound healing time in the four current surgical methods for PD. This cross-sectional study was conducted in the Department of Surgery at the Baqiyatallah University Hospital, Tehran, Iran, from April 2017 to September 2017. The study was carried out on 182 postoperative patients. Surgeries were performed in different methods such as; open, closed, semi-closed and limited excision. Diabetics, obese patients and patients with acute pilonidal abscess or prior PD surgery were excluded. All patients were followed for at least three years after surgery. During the follow -up period, patients were assessed for recurrence, satisfaction, complications rate and wound healing time. The outcomes were assessed by case notes analysis and follow-up telephone and postal questionnaires. In this study forty-four patients were operated via closed Method, 48 patients through open, 48 via semi-closed and 42 one's trough limited excision methods. The highest rate of recurrence was in the open group. There were no cases of recurrence in the closed group. There were also less postoperative hemorrhage and faster wound healing in the closed group. The average satisfaction of all patients was 88.9±8.7. The mean satisfaction rate in the closed group was 95.9±5.3 which was higher than other groups. The results of this study demonstrated that in the non-recurrent cases of sacral pilonidal sinus, complete Excision and primary repair have fewer complications and shows higher satisfaction rate.

The prevalence of autism spectrum disorder (ASD) as a child neurodevelopmental disorder has increased significantly during the past 3 decades worldwide and in Iran. This chronic disease does not cause premature death and there is no definitive treatment. Thus, the cost of ASD is extremely heavy and overwhelming. The purpose of this study is to calculate the economic burden of ASD in Iran. A cross-sectional descriptive-analytic study was conducted to calculate all-important ASD costs. Two hundred and ninety autism patients in Tehran participated in this study in 2017 with the support of Tehran University of Medical Sciences (TUMS). A valid and reliable questionnaire was used to estimate direct medical costs, direct non-medical costs and indirect costs. The annual economic burden of ASD is estimated to be 223,561,841 Rials ($6,883 2014 USD) per patient in Tehran, Iran in 2017. Approximately 32%, 52% and 16% of the total cost were direct medical costs, direct non-medical costs, and indirect costs. The average ASD direct cost was $5,765 of which 38% was direct medical costs and 62% was direct non-medical costs. The average annual ASD direct medical cost was $2,215 per patient of which 70%, 16% and 7% were related to rehabilitation, medicine and doctor visit costs. The average annual ASD direct non-medical cost was $3,550 per patient of which 35% was the cost of parents’ immigration to Tehran to receive health care services. The average annual ASD indirect cost for productivity loss from unemployment or reduced work productivity was estimated at $1,118. The largest cost component was parents’ productivity loss due to caregiving (70%). Autism imposes substantial direct and indirect economic effects on patients and their families. Hence, health policy makers must take the most effective measures to make best use of scarce societal resources, to reduce the cost of the disease for patients and their families and subsequently, reduce its psychosocial burden.

According to the previous studies, stress influences on eating behavior and is associated with unhealthy food selection. Furthermore, the research literature indicates that stress, anxiety, and depression can cause polyphagia and overweight. The purpose of present study is to investigate the relationship between depression, anxiety, and stress scales and dietary behavior in female high school students. The cross-section study was carried out from April to December 2016 on high school female students of Tehran City by confirmation and protection of Nutrition Sciences and Food Technology Faculty at Shahid Beheshti Medical Sciences University, Tehran, Iran. 400 samples were selected by using multistage cluster sampling method. After receiving consent and recording socio-economic information, the data associated with stress, anxiety, and depression score were collected by a short questionnaire of Depression Anxiety Stress Scales 21 (DASS-21). In order to survey the dietary behavior of students, the 168-item semi-quantitative food frequency questionnaire (FFQ) was applied. In addition, to assess the association between dietary behavior and stress, anxiety and depression, chi-squared test and logistic regression model were employed. Based on the results of the present paper, 49.8 percent of students, studied in this research, had stress levels, 56.3 percent of them suffered from anxiety and 55.3 percent of them had depression levels. The salt intake amounts of students who had high stress, depression, and anxiety, were more than of normal ones (respectively P=0.01, 0.02, 0.006). Additionally, fast food consumptions of students, suffering from anxiety, were also higher than normal (P=0.07). Subjects, which were categorized in depressed group, rarely eat natural fruit juice (P=0.03), and, stressful students use few natural fruit juices (P=0.006) and few fresh fruits too (P=0.02). Students with levels of stress, depression and anxiety in comparison to normal students, have more undesirable food habits, such problems may lead dietary behavior to unhealthy foods. More studies are required to clarify the relationships between dietary behavior and stress, depression and anxiety.

There are contradictions in the role of genetic variations and food group intake on metabolic syndrome (MetS). This study was aimed at examining the interaction between food groups and CCND2 rs11063069, ZNT8 rs13266634 and MC4R rs12970134 polymorphisms, regarding MetS and its components. In this matched nested case-control study (2006-2014), the data of 1634 (817 pairs) case and controls were selected among participants of the Tehran Lipid and Glucose Study (TLGS). The cases and controls were matched by age, sex and number of follow-up years. Dietary intakes were assessed using a valid and reliable food frequency questionnaire. Polymorphisms were genotyped. A significant interaction was observed between rs12970134 and green vegetable, read meat, and soft drink, in relation to the risk of low high density lipoprotein cholesterol (HDL-C), high triglyceride (TG) and high fasting blood glucose (FBG), respectively (P<0.05). The consumption of vegetables altered the effect of rs11063069 on MetS. Among G allele carriers, being in the highest quartiles of vegetables intake had a decrease risk of MetS, compared to those in the lowest quartile (P=0.007), but this trend was not observed in AA genotype carrier. There was also a significant interaction between rs13266634 and salty snack and fish intakes, in relation to the risk of abdominal obesity (P<0.05). Increasing salty meals by CT+TT genotypes carriers increased the odds ratio of abdominal obesity, while in the CC genotype, this increase was not observed. A significant interaction was also observed between rs11063069 with other vegetables, red-yellow vegetable and fruit intake respectively, regarding the risk of high FBG, low HDL-C and high blood pressure (P<0.05). The present study demonstrates the interaction between food groups and MC4R, ZNT8 and CCND2 polymorphisms. To reduce the risk of MetS, high risk allele carriers of rs12970134 must avoid meat consumption, while in high risk allele carriers of rs11063069 and rs13266634, vegetables and fish should be consumed.

Phototherapy is the most effective treatment for neonatal jaundice and intermittent phototherapy is as effective as continuous phototherapy but with fewer complications and more benefits. This study compared the hospital length of stay, duration of phototherapy and the reducing rate of total serum bilirubin after 24 and 36 hours of phototherapy in two groups. The current double-blinded randomized controlled trial was conducted on 60 icteric term neonates from November 2016 to June 2017. A total of 60 icteric term neonates were randomly divided into two groups. In the continuous group, the phototherapy device was turned on for 24 hours and in the intermittent phototherapy group, the phototherapy device was turned on for 18 hours and off for eight hours. Inclusion criteria were term neonates with non-hemolytic hyperbilirubinemia admitted to the neonatal ward of Loghman Hospital, Tehran, Iran. Infants were excluded for any of the following reasons: Hemolytic anemia, prematurity, sepsis, sever hyperbilirubinemia (total bilirubin>18 mg/dl), direct hyperbilirubinemia and onset of jaundice within the first 24 hours of life. In both arms, phototherapy continued until total serum bilirubin reached<11 mg/dL.
Both early and late complications were compared including the length of hospital stay, duration of phototherapy, the rate of kernicterus, decreasing rate of serum bilirubin after 24 and 36 hours. The demographic parameters did not differ significantly between the intermittent and continuous phototherapy groups. The length of hospital stay was 2.3±0.60 and 2.46±0.93 days in the continuous and intermittent groups, respectively (P=0.516) and there was not significant differences between them. The duration of phototherapy was 45.26±16.39 and 46±11.82 hours in the continuous and intermittent groups, respectively, and they had no significant differences (P=0.843). The rate of serum bilirubin cessation in the two groups was similar after 36 hours. According to the current study results, intermittent phototherapy was as effective as continuous phototherapy to treat icteric full-term neonates. The intermittent phototherapy also helps to maintain mother-infant bonding and it is useful to maintain breastfeeding.

Genital warts are one of the most common sexually transmitted infections, 1% of sexually active population have anogenital warts (AGWs). According to previous studies, the disease affects people's quality of life and imposes financial costs on health systems. The present study is a case-control study at spring of 2018. The quality of life of 65 patients with anogenital warts that were referred to Boali-sina Hospital in Sari, Iran compared with 65 control subjects. The World Health Organization Quality of Life Brief (WHOQOL-BREF) questionnaires was used. According to the results, among the patients with anogenital warts, the quality of sexual contact in majority them were not affected by the disease (70%). The total cost of treatment was less than the monthly income of the family until the time of participating in the study (92%). There was no significant difference between the mean and standard deviation of physical health scores and mental health scores in the control and patient groups. (Respectively P=0.14, P=0.93). There was no significant relationship between the mean of physical health scores with disease severity. However, there was a significant difference between the mental health score in the two groups of patients with low and high levels of severity (P=0.01). Physical health scores in the whole sample have a significant relationship with gender, so that, in women, physical health score was lower than that of male, but the mean score of mental health in both male and female patients was not significantly different (P=0.18). In the control group the score of mental health was lower in women (P=0.041). In patients with anogenital wart, quality of life doesn’t change significantly, although, mental health scores directly related with disease severity.

Hepatitis B is the most common blood-borne viral infection that is considered as a major public health problem of the world's major health problems. The aim of this study was to investigate the prevalence of hepatitis B virus (HBV) infection among blood donors referring to blood transfusion centers. This retrospective cross-sectional study was performed on 216004 volunteer blood donors referring to blood transfusion centers of Iran from the beginning of April 2011 to April 2015. Then the positive hepatitis B surface antigen (HBsAg) test was performed using the enzyme-linked immunosorbent assay (ELISA) and neutralization methods. Of the 216004 blood donors, 279 (12.12%) were positive for HBsAg, and the incidence of infection was a decreasing trend over a four-year period. Among HbsAg positive cases, 97.14% and 2.86% were male and female, respectively. Significant differences between males and females were found (P=0.000). The number of HBsAg positive cases among married people (238 cases, 85.3%) in compared with single people (41 cases, 14.7%) was significantly higher (P=0.000). The average age of HBV infected cases was 39.6±10.3 years. Most HBsAg positive cases were 45-36 years old (30.8%) and lowest prevalence was seen in the age group above 56 years old (4.6%). Highest infected people with Hepatitis B Virus had low degree of education. Relationships between HBV infection with age and degree of education were statistically significant (P=0.000). The results of this study showed that based on our findings, prevalence of hepatitis B surface antigen among blood donors have declined significantly during the four years of study.

Breast cancer is one of the most common worldwide malignancies among women. Biological data suggest that damage induced by endogenous and exogenous factors affects the integrity of DNA and associated with susceptibility to breast cancer. Single nucleotide polymorphisms (SNPs) in DNA repair genes can associated with differences in the repair efficiency of DNA damage and may affect breast cancer. The XRCC3 protein participates in DNA double-strand breaks and recombinational repair, in other words the product of XRCC3 gene, plays a key role in homologous recombination repair of DNA double-strand breaks. The polymorphism of FokI plays critical roles in breast cancer development. The aim of the present study was to evaluate associations between the risk of breast cancer and FokI polymorphism in the XRCC3 gene. This case-control study was carried out on the women with breast cancer and healthy women located in Markazi province at Arak University Research, Iran, from October 2016 to March 2017. In the present study, the association of FokI polymorphisms and the risk of breast cancer was assessed by Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) techniques. In this method, genomic DNA was extracted from blood samples using the kit procedure. Then, PCR was performed and the SNP-containing DNA amplicons were subjected to digestion of enzymes. Following digestion, each sample was immediately analyzed by 3% agarose gel electrophoresis. Statistical analysis was done using SPSS and SNP Analyzer softwares and the final results were determined. No statistically significant difference was observed between the two groups of patients and controls for three genotypes the site rs1799794 (P=0.435). Genotype AG (P=0.384, OR=0.614, CI=95%, 0.205-1.840) and GG (P=0.867, OR=0.911, CI=95%; 0.308-2.699) had no significant associations with risk of breast cancer. There was no significant association between FokI polymorphisms of the XRCC3 and risk of susceptibility to breast cancer, which was in accordance to some researchers. FokI polymorphisms of XRCC3 gene cannot be used as a biomarker in clinical predictive studies in relation to risk of breast cancer.