Iranian Journal of Public Health
Volume:37 Issue: 2, Summer 2008

The use of cardiac surgical database is necessary for evaluating and improving the quality of care. The aim of this report was to provide useful information for surgeons in Iran and other countries for their daily practice. We analyzed data from 14288 consecutive patients in four different types of procedures, namely isolated coro nary artery bypass grafting (CABG), combined CABG and valve (CABG-V), only valve (V), and other adult cardiac surgical op erations from 2002 to 2006. The activity load increased from 1765 in 2002 to 3309 surgical operations in 2006 with almost 87.2% of activity be ing isolated CABG. The mortality rate for CABG was 1%, which decreased from 1.7% to 0.9% over the five years. The mor tality rates for CABG-V and V were 5.8% and 4.8% in the last year of the study, respectively. Over the 5 yr period, the pro portion of urgent operations increased substantially from 4% to 24.5% (P< 0.0001), causing a reduction in elective op erations. The mean length of hospital stay for the entire population was 8.38±5.74 d, which remained almost steady dur ing the study period. This database can serve as a valuable resource of preoperative measurers and surgical outcomes for surgeons and researchers with a view to improving overall surgical performance.

Acanthamoeba castellanii is the important cause of amoebic keratitis in Iran. The key molecule in pathogene sis of Acanthamoeba keratitis is Mannose Binding Protein (MBP) led to adhesion of amoeba to corneal epithelium. Subse quent to adhesion other cytopathic effects occur. The goal of this study was to identify the molecular characterization of a gene encoding MBP in an Iranian isolate of A.castellanii in order to pave the way for further investigations such as new therapeu tic advances or immunization. A.castellanii was cultured on non nutrient agar. Extraction of DNA was performed by phenol-chloroform method. After designing a pair of primer for the gene encoding MBP, PCR analysis was performed. Finally, the PCR prod uct has been sequenced and the result submitted to the gene data banks. An MBP gene of 1081 nucleotides was sequenced. This fragment contained three introns and encodes a protein with 194 amino acids. Homology search by Blast program showed a significant homology with the MBP gene in gene data banks (96%). Besides, the identity of amino acids with the other MBPs in gene data banks was about 86%. We isolated and sequenced a gene fragment encoding MBP in an Iranian isolate of A.castellanii. Molecular characteri zation of this important gene is the first step in pursuing researches such as developing better therapeutic agents, im mu nization of population at risk or even developing a diagnostic tool by PCR techniques.

Cholera, an infectious disease caused by Vibrio cholerae, is primarily transmitted by ingestion of contaminated food or water. In severe cases, cholera may lead to severe dehydration, metabolic acidosis, and ultimately, hypovolemic shock and death. In this study V.cholerae non-O1 was cultured in suitable media. LPS was extracted from the surface of bacteria by hot phenol-water method and then purified by high-speed centrifugation. For production of specific antibody against LPS, white newzeland rabbits were first immunized by whole cell bacteria and then immunized with highly purified LPS. The titre of the antiserum was determined by ELISA for each srogroup. Results presented in this study indicate that serum anti-LPS antibodies raised against purified LPS of V.cholerae non-O1 can detect V.cholerae non-O1. This antibody had low cross reactivity with V.cholerae O1, serotype Inaba or Ogawa. So, this antibody can use for detection of V. cholerae non-O1.

Assessment of national children growth has shown that a high percent of Country’s children are afflicted to growth failure. Community participation is one of the principles of PHC emphasized by WHO that is necessary for develop ment of health services. The objective of this study was to develop a model for mother’s participation in order to improving growth and nutrition of children. This community-based field trial was rendered on 74 pairs of mothers and children less than three years of age. A model was designed for increasing mother’s participation, so that, a group of mother’s volunteered and were instructed in the subjects of growth monitoring and child nutrition. The program was evaluated by CIPP Model (Context, Input, Product, Proc ess). Difference between the mean grade of mothers’ knowledge and practice, before and after intervention were mean ing ful (P< 0.001).This plan had considerable effects on the increase of individual and social capabilities of the partici pants, including their self-confidence. Other findings were related to the evaluation of impact, effectiveness, sustainability and transportability of the program. By enhancement of mother’s participation, considerable improvement of their knowledge and practice concern ing growth and nutrition of children were achieved. Also individual and social capabilities of the mothers’ in creased.

Ubiquitin, an 8.5 kDa peptide that marks other proteins for proteasomal degradation, tags defective sperm dur ing epididymal passage. Thus, sperm ubiquitination is a universal marker for sperm defects and can be used as a sperm func tion test. The objective of the present study was to examine the relationships between sperm ubiquiti nation and clinical se men parameters, using simplified immunofluorescence assays in order to establish ubiq uitin as a biomarker of male infertil ity. Semen samples from 100 couples attending Avicenna Infertility Clinic, Tehran, Iran, were collected and ana lyzed ac cording to WHO criteria. Each sample was washed and adjusted at 106 sperm/ml concentration. Sperm were coated on slides, using cytospin centrifugation and were fixed in buffered formaldehyde. Subsequently ubiq uiti nated spermatozoa were evaluated by direct immunofluorescence microscopy using FITC-labeled anti-ubiq uitin antibodies. After counting at least 200 sperm per sample, while employing light microscopy, the percentage of ubiq uitinated spermatozoa was recorded on the same fields through epifluorescence microscopy. Negative correlations were obtained between sperm ubiquitination and sperm count (r=-0.278, P< 0.001), sperm concen tration (r=-0.37, P< 0.001), viability (r=-0.407, P< 0.001), sperm morphology (r=-0.509, P< 0.001), rapid progres sive motility (a) (r=-0.246, P< 0.001) and slow progressive motility (b) (r=-0.474, P< 0.001). There was a positive correla tion between ubiquitinated sperm and the percentage of immotile spermatozoa (r=0.486, P< 0.000). Increased sperm ubiquitination is inversely associated with good semen quality parameters, supporting the use of ubiquitin as a biomarker for evaluation of human sperm quality.

To obtain information about clinical isolates of Aspergillus flavus group. We examined 55 isolates [45 clinical, 10 reference (6 from culture collections, 4 local reference)] for toxicology, growth rates, and morphological and physiological characteristics. Modified Czapek Agar (CZ) and Malt Extract Agar (MEA) were used for observing microscopic morphology and measuring fungal structures. Two additional media, Potato Dex trose Agar (PDA) and a modified Rice Agar (RA), were used to detect fluorescence under UV light. The presence of afla toxin in culture extracts was confirmed by thin-layer chromatography (TLC). 66.6 and 55.5 of clinical samples showed different shade of fluorescence on RA and PDA, respectively, after expo sure to UV light. Fifteen (33.3%) of the clinical isolates and 3 (30%) of the reference strains produced sclerotia on Czapek Yeast Agar (CYA) at 37° C. Sclerotia formation was promoted at 37°C in comparison with 28°C on CYA medium (P< 0.001). Five (11.11%) of the clinical isolates, the Iranian A. flavus soil reference strain and A. parasiticus ATCC15517 were confirmed to be aflatoxiginc by TLC. From two clinical toxigenic isolates (of 5) which were fluorescence positive on PDA, only one produced fluorescence on RA after exposure to UV light. Moreover sclerotia production was observed in only 3 of 5 toxigenic isolates. Furthermore one isolate from a sinus specimen was identified as Aspergillus oryzae. This is be lieved to be the first report of sinusitis due to A. oryzae from Iran. Some of clinical A. flavus isolates could have aflatoxin and sclerotia producing ability, but not necessarily all aflatoxi genic A. flavus isolates are capable of producing sclerotia.

Hox genes are well-known transcription factors that play essential roles in directing embryonic development. TGIFLY is a Y-linked homeobox gene that was originally identified by virtue of its expression in adult testis. The functions of TGIFLY in normal and abnormal development are unknown. To investigate the potential roles of TGIFLY gene in the infertile males, a semi-nested Reverse Transcriptase Po ly merase Chain Reaction (RT-PCR) was performed on the testicular samples of 110 patients with non-obstructive azoosper mia. The expression of TGIFLY in 59(53.6%) out of 110 patients were undetectable. Patients with different sper mato gene sis defects failed to show the expected in TGIFLY gene expression as demonstrated in the normal testes. Our results indicate that TGIFLY is expressed in testis and could be associated with infertility in patients with azoo spermia. TGIFLY may be required for the regulation of spermatogonial stem cell specification and proliferation that is es sen tial to the establishment and maintenance of spermatogenesis in human.

Cercariae (larva of helminth parasites) are covered by a thick glycocalyx coat, which serves as an osmotic pro tection during their free existence, and contain carbohydrates conjugated as glycoproteins, glycolipids and mu co polysaccharides. Although, limited studies have been made on life cycle of cercariae from fresh water snails, however, car bo hydrate studies on cercariae have not been done in Iran so far. This study was made to determine the cercariae speci fica tions from Lymnaea gedrosiana and evaluation of surface carbohydrates as receptors for host lectins in a host-parasite rela tionship system as a model in human schistosomiasis including cercarial dermatitis in Khuzestan Province. For this purpose, snails were collected from Dezful region in Khuzestan Province and cercariae were obtained by shed ding method and identified by valuable keys. Experimental infection was established in the Culex pipiens (Culicidae mos quitoes) larvae for further identification and mode of adhesion. To detect the mode of adhesion, surface carbohydrates of cercariae were detected by lentil (Lens culinaris) lectins. Examined snails were infected with xiphidiocerceria of trematodes and metacercariae were obtained from Culex pipiens. Also, Mannose monosaccharides- CH2OH (CHOH) 4CHO - were detected particularly on the glands of cercariae. Adhesion of cercariae to their host by lectins-carbohydrates bonds is the first stage of host-parasite relation ship. This phenomenon could be happened for animal schistosome’s cercaria in cercarial dermatitis.

Gastroesophageal reflux disease (GERD) is prevalent in the West. Mayo-GERQ is one of the most widely used questionnaires for screening GERD. We validated GERQ in an Iranian population. The Mayo-GERQ was translated into Persian (P-GERQ) and reviewed and commented by two gastroenterolo gists. Eleven lay-people filled it in and commented on it. Reliability was assessed by test-retest within 2-6 wks in 53 hos pital staff. Concurrent-validity was checked in another 53, comparing the results of the self-administered questionnaire with the questionnaires filled in by a gastroenterologist interviewing them. Weighted-kappa (w) statistics was used. Time needed to complete the questionnaire, practicability of the directions and linguistic eloquence were checked (feasibility indi ces). Results were used to modify P-GERQ. The modified P-GERQ was tested in another 99 hospital employees in the same man ner. Phase-one; One-hundred seventeen subjects were enrolled (46 men). Mean time for completion was 23.7 minutes. Mean kw for reliability was 0.47 and that for validity 0.26. Sources of poor performance were sought, P-GERQ was revised and underwent validation again (2nd phase). Phase-two: Ninety-nine individuals were enrolled (37 men). The modified P-GERQ took 15.8+/-11.9 min to complete. -values for concurrent-validity of major symptoms (acid-regurgitation, heart burn) were 0.70 and 0.67 respectively. Corresponding -values for reliability were 0.57 and 0.80. P-GERQ was not valid initially. After making appropriate technical and linguistic changes, it achieved accept able validity, reliability and feasibility. In addition to making available a useful tool for population-based studies, our re sults underscore the importance of validation before adopting a translated questionnaire.

This study was conducted to determine of molecular epidemiology of the Giardia lamblia by PCR-RFLP method in Tehran, capital of Iran. Thirty eight stool samples were randomly selected from 125 patients diagnosed with giardiasis using microscopy in Tehran. DNA extraction of some samples were performed by phenol/chloroform/isoamyl alcohol method and to raise the sen sitivity of the PCR assay, the genomic DNA of the others were extracted using glass beads and the QIAamp Stool Mini Kit in order to effectively remove the PCR inhibitors. A single step PCR-RFLP assay, targeting the glutamate dehydro genase (gdh) locus, was used to differentiate within and between assemblages A and B that have been found in humans. Of the 38 isolates, 33 samples (87%) were found as G. lamblia (genotype AII), 3 (7.8%) belonged to assemblage B, genotype BIII, the mixed of genotype AII and B were detected only in two samples (5.2%). PCR-RFLP is a sensitive and powerful analytical tool that allows effective genotype discrimination within and between assemblages at targeting gdh gene, and makes it possible to identify the presence of mixed genotypes. Our data sug gest that there is an anthroponotic origin of the infection route, assemblage A group II, in Tehran so it seems that the main reservoir of Giardia infection is humans in the area studies.

Epidemic and endemic cholera is a major public health problem for many countries. Aim of this study was to evaluate AP-PCR for investigation of clonal relatedness among the strains of Vibrio cholerae recovered from an out break occurred in different parts of Iran in 2005. The study was conducted during the cholera outbreak occurred in some of provinces in Iran in summer 2005. Bac terial isolation and identification was carried out according to the standard bacteriological methods. Arbitrarily primed PCR (AP-PCR) used to study the genetic relatedness between the V.cholerae isolates. Thirty-nine isolates of V.cholerae O1 were identified. All isolates belonged to serotype Inaba. AP-PCR could dif ferentiate the isolates into five groups. AP-PCR cluster types 1 and 2 were the most prevalent groups, accounting for 36% and 41%, respectively, of V.cholerae isolates. The most of epidemic strains of V.cholerae O1 isolated in the year 2005 could be attributed to two pre dominant clusters including AP-PCR cluster types 1 and 2 accounting for more than 77% of isolates. In conclusion, a few epidemic clones were responsible for the apparently epidemic occurrence of cholera in provinces studied.

Adiponectin is a protein produced exclusively by adipose tissue; the reduced level of which has been shown to be involved in a variety of obesity-related disorders, such as insulin resistance and diabetes, in different eth nic groups. This cross-sectional study was conducted to determine adiponectin level and its association with insu lin sensitivity in 20 adult overweight type-2 diabetic and 20 healthy over-weight non-diabetic Iranian men for the first time. Body fat mass (Bio-electric impedance), serum level of adiponectin (ELISA), fasting blood sugar and fasting in sulin were measured. Insulin sensitivity was calculated using QUICKI. As expected, the mean adiponectin concentration was lower in diabetics (7.7 ±3µg/ml) than non-diabetics (8.1 ± 2µg/ml); however, the difference did not achieve statistical significance (P= 0.5). Adiponectin negatively cor related with fat mass. This correlation was stronger in diabetics with a higher fat mass (r= -0.3 in diabetics vs. r= -0.01 in non-diabetics; p: N.S.). Adiponectin positively related with insulin sensitivity in both groups, although this rela tion was only statistically sig nificant in non-diabetics (r= +0.5; P= 0.04). The relation between insulin sensitivity and mean of adiponectin level was mar ginally significant even after adjustment for group (diabetic and non-dia betic), age and fat mass. Our findings are consistent with the studies on different ethnic groups which have indicated lower adi ponectin lev els in diabetics. Also our results confirm the relationship between a low adiponectin level and insulin sen sitivity reported in earlier studies.

Strengthening exercises are not favored in the rehabilitation of patients after coronary artery bypass grafts (CABG) for concerns over potential adverse effects. However, patients often present with weakened skeletal muscles post CABG due to disuse. We studied the effects of aerobic and strengthening exercises on the serum C-reactive protein (CRP) levels and blood pressure in 79 post CABG patients aged 40-60 years. Patients were randomly assigned to one of four programs five days per week, consisting of either aerobic exercises alone (controls) or combined with strengthening exercises (experimen tals) at moderate intensity. The serum CRP levels were quantified at the beginning, 12th and 24th sessions, and at 3-month fol low-up. Patients’ blood pressure was measured before and after each exercise session. Patients were re-evaluated at 3-month follow-up. There was a mild but significant increase in the CRP levels at 12th session in all groups. Patients systolic blood pres sures declined by 2%-7% at 12th and 24th sessions, respectively. There was no significant difference in changes of blood pres sure among the groups. The results suggest that the four exercise programs were equally safe in low-risk, post CABG patients. Exer cises did not promote a systemic inflammatory response. These beneficial effects were still evident at 3-month follow-up.

Since the earliest days of medicine, the tongue has been considered a good reflection of systemic disease. Hip pocrates, Galen and others considered the tongue to be barometer of health. In addition, the early diagnose of tongue le sions help to recognize the some systemic diseases. The purpose of this study was to determine the frequency of different mor phological variations (anomaly) of the tongue in a population of school children aged 6-12 years in Hamadan, Iran. This cross sectional study was held with questionnaires and face-to-face interview among 1600 schoolchildren 6- 12 years old (800 girls, 800 boys) with cluster randomize method were selected and examined. Each school was considered as a cluster that was selected by randomized selections in view of the total sample size. Tongue lesions were found in 39.7% of the children. Overall, the most frequent condition was geographic tongue (27%) and fissured tongue (12.9%). Microglosia and median rhomboid glossitis were in 0.2% of cases. The present study indicates a higher frequency of tongue abnormalities specially geographic tongue than previ ous studies however further investigation are required to indicate if hereditary and congenital factors play a vital role or if the environmental factors in this region vary with those in their regions. On the other hand the findings from this survey should serve as a baseline for future studies.

β-thalassemia is a common autosomal recessive disorder resulting from over 200 different mutations of beta glo bin genes. The aim of the present study was to identify the distribution and frequency of the most com mon β-thalassemia mu tations among the population of Isfahan Province in central Iran. The data presented here were derived from a total of 114 β-thalassemia chromosomes of 18 affected pa tients and 78 unrelated carriers identified in our screening program. Furthermore, 23 pregnant women were analyzed among couples with a PND request for β-thalassemia. Allele identification was carried out using routine Reverse Dot Blot, ARMS, and ge nomic sequencing. The most common mutation, IVS-II-I, followed by FSC-36-37, IVS-I-5, FSC-8-9, IVS-I-110, IVS-I,3’-end; -25bp, IVS-II-745, FSC-8, Cd-39, FSC-22-24, IVS-I-1, Cd-44, IVSII-2,3 (+11/-2), IVS-I-6, and FSC-16, respectively. The pre sent study not only provides a guide for distribution and frequency of both recurrent and uncommon mutations, but also for the first time, reports a rare -thalassemia mutation, IVSII-2, 3 (+11/-2), in the Isfahan province of Iran. The information presented here could greatly facilitate screening for β-thalassemia and prenatal diagno sis in the prov ince of Isfahan.

There are various ethical approaches in the history of philosophy. Beauchamp and Childress introduced four basic principles which were acceptable in all communities: beneficence, non-maleficence, respect for autonomy and jus tice. Yusuf Khass Hajib is the first author of the Islamic Turkish Literature whose work was found out. This study aims to reveal the existence of four principles of bioethics in this work, in Kutadgu Bilig, presented to the prince of Karakhanids, Tavgach Bugra Khan, by Yusuf Khass Hajib in 1069-1070. It was found out in this study that all these principles were included in Kutadgu Bilig in different forms. The principles that Beauchamp and Childress argued to be acceptable in all communities and all cultures have already existed in different communities in different ages. Yusuf Khass Hajib’s work, Kutadgu Bilig, constitutes a good example of this reality.

Hymenolepis diminuta is a cestode frequently found in rodents and humans. Species of flour moths of the genus Pyralis and bee tles in the genus Tribolium are common intermediate hosts. Humans can be accidentally infected through the ingestion of the insects, including larvae in precooked cereals, dried fruits or other food items, and directly by ingesting the insects from the environment. This tapeworm, while infrequently encountered, has been reported from many parts of the world. In this paper we report the first case of infection with H.diminuta in Iran since 1972.