Iranian Journal of Public Health
Volume:36 Issue: 3, Autumn 2007

Abstract: Influenza A viruses bearing all known HA and NA subtypes have been isolated from avian hosts: but only the A/H1N1,A/H2N2 and A/H3N2 influenza subtypes have been associated with widespread epidemics in humans un­til now. While influenza B detected only in humans. Subtype H5 infection in humans occurred for the first time dur­ing 1997-1998 in Hong Kong, then China in 2003, Vietnam and Thailand in 2004 and continued to 2005-2006 in Tur­key and Egypt. In this study a Multiplex Nested RT-PCR was developed for simultaneous detection of influenza virus A and B in clinical samples. Throat swab and throat wash was collected between October 2005 and September 2006 from 689 patients with a suspected influenza virus infection. Samples were transported to the National Influenza Center (Tehran Univer­sity of Medical Science, School of Public Health). Each sample is divided into two parts in order to virus isolation and nested RT-PCR. The RT-PCR detected in 75 cases of influenza A and B, compared to 26 cases by virus isolation and 74 cases are positive by RT-PCR. In total, 50 out of 74 RT-PCR positive specimens were negative by virus isolation. The RT-PCR provides a sensitive and specific method for detecting and typing influenza viruses A and B. The RT-PCR provides a sensitive and specific method for detecting and typing influenza viruses A and B. Multi­plex RT-PCR can also be used to accurately detect more than one viral template in the same reaction mixture, allow­ing viral confections to be identified with the same respiratory specimen.

Abstract: To assess the utility of the chromosomal ail virulence gene sequence for detection of pathogenic Yersinia en­terocolitica in raw meet food products (beef, lamb, and chicken). This study included 39 Yersinia enterocolitica positive cultures from suspicious food samples, in a working pe­riod of six months. These samples were referred to the "Food-Borne Diseases and Chronic Diarrhea Lab at Research Cen­tre for Gastric and Liver Diseases" of the Taleghani Hospital at Shahid Beheshti University of Medical Sciences, Te­hran, Iran. Isolates from 8 cultured Y. intermedia, Y. aldovi, Y. intermedia type O:45, Y. kristensenii, Y. enterocolitica type O:12/26, Y. enterocolitica type1/7/8, Y. frederiksenii type O:39, and Y. enterocolitica type O:8 samples were in­cluded in the study. Four non-Yersinia species Salmonella typhi, Shigella dysenteriae, Shigella flexeneri, and Proteus mirabi­lis were used for specificity testing. An established Yersinia type O:9 was used as positive control and for sensitiv­ity testing. An in-house real-time PCR assay was designed in order to rapidly and specifically identifies the pres­ence of specific Yersinia species. Out of 39 tested Y. enterocolitica samples, 6(2.3%) showed positive results for the ail gene PCR prod­uct, typed as O:8, and O:9, respectively. PCR products were sent for sequencing. Two sequences were registered with the Na­tional Center for Biotechnology Information (NCBI Genbank) as polymorphic ail gene sequences under the acces­sion numbers of DQ157767 and DQ003329. Collectively, this test is well adapted for definite confirmation of pathogenic Y. en­terocolitica in food sam­ples.

Abstract: Strongyloides stercoralis, the etiological agent of strongyloidiasis, is one of the most common parasitic nema­tode with the unique ability to complete its life cycle and proliferate within the host. Although it is an endemic parasite in Iran, no molecular characterization is available on isolates originated from the country. Therefore, this study was con­ducted for molecular identification of human Strongyloides isolates in the three most prevalent provinces. After microscopical examination and agar plate culture of nearly 1500 stool samples, 20 isolates of S. stercoralis filari­form larvae were recovered from (Gilan and Mazandaran in north and Khouzestan in south) of Iran. The genomic DNA was extracted from all these samples and two primer sets were selected for amplification. ITS1 region of the rDNA gene was amplified by a nested Polymerase Chain Reaction (nested-PCR). The PCR prod­ucts were sequenced and analyzed in compari­son with the sequences deposited in GenBank. DNA sequence analysis of ITS1 region showed that all the 20 isolates were S. stercoralis. There was slight varia­tion in the ITS1 region among the isolates. ITS1 sequencing seems to be a valid target for molecular identification of S. stercoralis.

Abstract: Laboratory bred sand flies are essential for the study of different biological phenomena including the transmis­sion dynamics of Leishmania. The aim of the study was to determine the suitable situation for colonization and main­tenance of Iranian strain of Phlebotomus papatasi at laboratory conditions from an endemic focus of cutaneous leishmani­asis due to Leishmania major. One hundred and thirty P. papatasi were collected by CDC miniature light traps and aspirator from indoors in Badrood, central Iran. The fly was maintained by the procedures of Modi & Tesh (1983) with minor modifications for 7 generations. Minimum and maximum rate of productivity was calculated to be 8.5 and 56.1 in F7 and F3, respectively and signifi­cant difference was observed among productivity of some generations (P< 0.001). The sex ratio ranged between 70(F1) and 101.8(F6). The mean duration of egg to adult emergence varied between 47.21±4.46 and 52.6±7.85 days. The life cycle was completed in 34.4 to 60 days at 26±1 ºC. P. papatasi was colonized and maintained successfully for the first time as a laboratory strain. Using larval diet without liver powder is recommended. The blood of white hamster was preferred to golden hamster and guinea pig for the sand fly vector blood feeding at the insectary.

Abstract: To assess the distribution and resistance of the pathogens responsible for septic arthritis and osteomyelitis over a 10 years period in children admitted to Children''s Medical Center Hospital, Tehran, Iran. Microbiologic and clinical presentation reports from 145 cases of septic arthritis and osteomyelitis from March 1995 to February 2005 were retrospectively reviewed. Of 145 cases, 71(49%) had positive culture: 71.8%(51/71) of organisms were isolated from synovial fluid alone, 8.4%(6/71) from blood culture alone and 19.7% (14/71) from both synovial fluids and blood cultures. Staphylococcus aureus was the most common pathogen isolated, making up 60.5% of all positive cultures, followed by Klebsiella spp. (14%) and coagulase-negative staphylococci (8.4%). Thirty eight percent of S. aureus and 84% of coagulase-negative staphylo­cocci isolates were resistant to cloxacillin. All isolates of S. aureus were susceptible to clindamycin and also, 89% were susceptible to vancomycin. Among Klebsiella spp., amikacin was shown to be very effective, with susceptibility rates of 100%. Haemophilus influenzae was identified in only 2% of all patients. The present study highlights the importance of characterizing the etiology and antibiotic susceptibility of organ­isms causing septic arthritis or osteomylitis in children.

Abstract: Trichomonas tenax, a commensal flagellated protozoan, inhabits in human oral cavity. This parasite is cos-mopoli­tan and frequently found in patients with poor oral hygiene and advanced periodontal disease. There is only one pub­lished study that rebound the prevalence of this parasite in Iran. This PCR based study compared the prevalence of oral tricho­moni­asis in patients with oral diseases and a healthy control group. From May 2005 to April 2006, the subgingival dental plaques of 160 patients with gingivitis or periodontitis and 160 controls who attended to Dental School of Shaheed Beheshti Medical University, Iran were taken and examined by wet mount smear, and Giemsa staining. Likewise, a PCR protocol was developed for specific detection of T.tenax using a pair of prim­ers designed for its 18S rRNA gene. Thirty three (20.6%) of patients were PCR positive while 28 (15.5%) were diagnosed using wet preparation and Giemsa staining. In the other hand, 2 (1.9%) of control group were identified positive by PCR procedure. The prevalence of oral trichomoniasis in our study (20.6%) was compatible with many other published reports which mostly has ranged from 12%-32%. The study revealed dependence between the frequency of occurrence of T. tenax and the state of periodontitis. The present PCR procedure could provide a simple and rapid detection method of T. tenax in dental plague.

Abstract: To describe the risk and the patterns of injuries taken place inside the primary schools among pupils in an Ira­nian community. A total population of 11,543 pupils were followed and all injuries were recorded. Information about age, gen­der, deprivation, time, day and month of injuries, cause and the outcome of injuries were collected using a checklist. One hundred and twenty five cases were reported giving an overall one-year incidence rate of 10.8 per 1000 per­son-years-at-risk. Overall incidence rate of injuries among boys was significantly greater than this incidence rate among girls (Relative Risk =1.6, 95% CI= 1.1 - 2.2). The greatest incidence rate was reported among year five pupils in both genders (18.6 per 1000 boys and 13.2 per 1000 girls). "Fall" was the most common cause of injuries followed by "hit by objects". Majority of injuries were "cured without rest" and only seven pupils were admitted in hospital. The level of risk calculated in this survey could be used in programs aiming to prevent injuries in primary schools and a nationwide surveillance system in the country is recommended.

Abstract: Quality assurance is implemented by the framework for the ISO 9001- 2000 " Quality Management Sys­tem "and ISO 15189: 2003. QA system will be more efficient if every organization''s employees are commitment to QA im­plementation. This survey aimed to correlate between knowledge, attitude and performance of the employees with QA system implementation and its indicators observation in Tehran University of Medical Sciences Hospitals'' Clinical Labo­ratories in 2003-2005. A Cross- sectional, descriptive analytical survey was accomplished with two types of questionnaires to col­lect Employees'' demographic information and determine knowledge, attitude and performance of the employees about QA system and its indicators observation in TUMS Hospitals Laboratories. Also, a checklist including 685 questions pub­lished by WHO and ISO 15189: 2003 requirement series was made to monitor preanalytical, analytical, and postanalyti­cal stage of fourteen TUMS Hospitals'' Clinical Laboratories. The data was saved by spss software and ana­lyzed by statistical method. The results showed that knowledge, attitude and performance of the employees for implementation and ob-serva­tion of QA system and its indicators are more increased and positive with increased level of their academic de­grees. QA programs and indicators would be programmed if all of the employees participated to implement QA pro­grams in these laboratories.

Abstract: Increased level of serum homocysteine is one of the risk factor of atherosclerosis. Its production related in some sulfur amino acids such as methionine. Some important cofactors that are involved in metabolic pathways of this amino acid are folate and vitamin B12. We have assessed the status of methionine, folic acid, and vitamin B12 in some coronary atherosclerotic male patients. In this case-control study, 46 cases of coronary atherosclerosis were selected from male patients aged 37 to 66 years undergoing coronary angiography. Of these, 21 had history of acute myocardial infarction (MI) in previous 3 to 36 months and 25 had angina pectoris. The controls were selected from male healthy volunteers. Inclusion criteria for all study participants required that they had no history of diabetes, hypertension, renal, hepatic, or gastrointestinal dis­ease, endocrinal disorders, or psychiatric illness. Nutritional status was assessed using biochemistry methods and estima­tion of nutrient intake. Serum methionine was determined by HPLC methods. Mean serum levels of vitamin B12, and folate, also erythrocyte folate concentration are significantly lower in these patients than in control subjects, but not for methionine. The ratios of serum methionine to vitamin B12 and folate were higher in patients than controls. Vitamin B12 and folate deficiencies, both, were higher in patients than controls. In summary, it is concluded that, despite normal level of serum methionine, coenzymes deficiencies may be one of the factors accounting for atherosclerosis.

Abstract: To monitor the current response of P. vivax to chloroquine in South and Southeast Iran. The study was undertaken from August 2004 until August 2005 at the Bandar- Abbas, Iranshahr, Nikshahr and Chabahar districts. A total of 195 patients out of 225 parasitologically positive P. vivax cases completed the study. The patients were given a standard 3- day regimen of chloroquine and followed-up clinically and parasitologically accord­ing to the world Health Organization guideline with some modifications. Results of study were addressed as mean of parasite clearance time (MPCT). The patients responded to the regimen of chloroquine within 24-120 hours. The MPCTs of P. vivax for Ban­dar- Abbas, Iranshahr, Nikshahr and Chabahar districts were 63.05(±15.37), 56(± 21.7), 70.92 (±6.51) and 58(±14) hours, respectively and for the whole study area (South and South East of Iran) was 63.50(±15.84) hours. The results of the whole studied areas indicate that difference of MPCT between male and female patients is marginally significant (P=0.05). Although, parasite clearance time for a number of cases occurred within96 and 120 hours, no P. vivax para­sites had reappeared in considered patients after day five within 28 days follow- up, reflecting that chloroquine is still an efficacious drug for the treatment of vivax malaria in the studied districts. Higher MPCT in Nikshahr district than the other districts indicating this could be an early sign for reduced susceptibility of the parasite to the drug.

Abstract: Job satisfaction remains as an important concern for both employer and employee. The leaving of work­place and migration to city centers is one of the main results of Job dissatisfaction among the primary health care (PHC) provid­ers in rural setting of Iran, Behvarzes. Determining the predictor''s factors of the PHC providers'' job dissatisfac­tion and provid­ing appropriate strategies to address these factors can most likely improve their performance and dimin­ish the prob­lem. Data were collected from 290 of the PHC providers worked full-time in Kurdistan rural health-house by a sur­vey for identifying the individual, environmental, and work factors that influence job satisfaction. Only 17% of the participants'' overall job satisfaction was high. Furthermore, the developed model presented sta­tistically significant differences between job satisfaction and village population size, satellite villages covered, and dis­tance between health-house and city center. It is expected that the finding of the study can help Iran health system policymakers and managers for plan­ning and implementing effective policies in order to meet the PHC providers'' needs and so improve quality of pri­mary health care in the rural areas.

Abstract: To evaluate the prevalence of obesity and some related factors in the villages around Gorgan which is a multi-racial and capital city of Golestan Province, northern Iran. This was a cross-sectional study with 2854 women participated. Interviewers recorded the data using the question­naire. Subjects were weighed on scales and had their height, waist, and hip circumferences. Economic status was categorized based on 10 consumer items considered necessary for modern-day life (Low >=3, Moderate = 4-6 and Good= 7-10). Three ethnic groups were compared in this study: Fars (native), Turkman and Sistani. This study carried out in rural area of Golestan Province in 2004. Body Mass Index (BMI) in ranges of (25-29.9), (30-39.9) and (>=40) was observed in 28.3%, 15.9% and 0.5% of the subject, respectively. The frequency of BMI over 25 among Fars(native), Turkman and Sistani mothers was 64.3%, 43.4% and 32.9%, respectively and statistical differences was significant (P< 0.02). In 39.1% of these women, the Waist to Hip Ratio (WHR) exceeded 0.8 and the index was higher in Turkman women compared with other groups. The frequency of economic status was 34.7%, 50.8% and 55.9%, respectively, without any significant difference. The preva­lence of obesity in literate women was significantly higher than in illiterate women (P< 0.04). Obesity is a common health problem among women in the rural areas of Gorgan and this abnormality is var­ied among three different ethnic groups in this region.

Abstract: Bone marrow transplant (BMT) recipients are prone to bacterial, viral and fungal infections. Bacterial infec­tion is considered as one of the common and serious complications in bone marrow transplant recipients. The aim of this study was to determine the rate of bacterial infections in bone marrow transplant recipients. Fifty-two blood and 25 catheter samples were obtained from 23 patients who were hospitalized in bone marrow trans­plantation unit in Shariati Hospital in Tehran. Bacterial strains were isolated and identified by the standard conven­tional bacteriological methods. Antimicrobial susceptibility was performed according to the guidelines from NCCLS using 18 different antibiotics. The strains of Staphylococci, Streptococcus viridans, Pseudomonas aeruginosa and Escherichia coli were isolated from 8(66.7%), 1(8.3%), 2 (16.7%) and the 1(8.3%) cases, respectively. Current study indicated that the bacterial infections particularly those caused by the Gram-positive cocci were still as important problem in bone marrow transplant.