Iranian Journal of Public Health
Volume:38 Issue: 1, Spring 2009

This was a population-based study to examine whether the campaign for World AIDS Day 2005 in Iran was suc cessful. A random sample of the general population was asked whether they had seen the campaign and knew the mes sage. They were also asked whether it was attractive; there was anything offensive, whether the campaign could raise aware ness, and how they rated the campaign. In all 1215 individuals were approached and 1014 agreed to take part in the study. Only 43% (n = 435) said that they had seen the campaign. Of those who had seen the campaign 79% knew the sub ject and 24% acknowledged the main message correctly. Only 27% said it was very attention getting or eye-catching, 64% said the campaign could raise awareness but 75% said the message was unclear, and confusing. A few respondents (23%) rated that the campaign overall looked good or very good. The findings suggest that if the World AIDS Day is an opportunity to give visibility to the problem, then there is an urgent need to think seriously to choose other approaches for raising global awareness on the state of the epidemic in Iran and elsewhere

Amelogenesis imperfecta (AI) is an inherited tooth disorder. Despite the fact that up to now, several gene muta tions in MMP20, ENAM, AMELX and KLK4 genes have been reported to be associated with AI, many other genes sug gested to be involved. The main objective of this study was to find the mutations in three major candidate genes including MMP20, ENAM and KLK4 responsible for AI from three Iranian families with generalised hypoplastic phenotype in all teeth. All exon/intron boundaries of subjected genes were amplified by polymerase chain reaction and subjected to direct sequencing. One polymorphisms was identified in KLK4 exon 2, in one family a homozygous mutation was found in the third base of codon 22 for serine (TCG>TCT), but not in other families. Although these base substitutions have been occurred in the signaling domain, they do not seem to influence the activity of KLK4 protein. Our results might support the further evidence for genetic heterogeneity; at least, in some AI cases are not caused by a gene in these reported candidate genes.

Organisms producing CTX-M-β-lactamase are emerging around the world as a source of resistance to oxyiminocephalosporins such as cefotaxime. However, the laboratory detection of these strains is not well defined. The aim of this study was to determine the presence and prevalence of known CTX-M-β-lactamases genes in clinical isolates of Escherichia coli from hospitals of Tehran. During six months (September to February, 2006), 160 clinical isolates of Escherichia coli collected from three university hospitals of Tehran. Phenotypic screening and confirmation tests for ESBL detection was according to CLSI advised. All of the ESBL-producing isolates were examined by PCR for presence of bla CTX-M genes. Primary phenptypic tests revealed that %56.69 (n=89) of E. coli isolates produced ESBLs. In confirmatory tests by use of clavulanic acid, ESBL production were confirmed (P+C+) in %96.7 (n=86) of isolates with primary positive test. The presence of an ESBL was not confirmed (P+C-) in 3.3% (n=3) of the screen positive. Of all screen positive isolates, 34 (35.78%) were positive for bla CTX-M genes from the CTX-M-I group, indicating CTX-M-1-like β-lactamases and Two (2.1%) were positive for bla CTX-M genes from the CTX-M-III group, indicating CTX-M-3-like β-lactamases. The remainder 59 (62.2%) were negative for bla CTX-M genes. The levels of resistance to ceftazidim were remarkably varible among CTX-M producers. This study provides futher evidence of the global dissemination of CTX-M type ESBLs and emphasize the need for their epidemiological monitoring.

In the present study, a PCR-RFLP based molecular technique was designed to rapid identification of der matophytes in clinical specimens. Skin scrapings obtained from human cases suspected to dermatophytosis were studied in or der to identify involved etiological fungi. In this experimental study, the specimens (skin scrapings) of patients referred to Mycology Department of Pas teur Institute of Iran were inoculated on Petri dishes contained selective agar for pathogenic fungi (SAPF) and incubated at 25º C until visible growth of fungal colonies. The colonies were examined for standard morphological characteristics after visi ble growth on the agar medium. A small portion of each fungal colony was further studied by restriction fragment length poly morphism (RFLP) analysis of the PCR-amplified internal transcribed spacer (ITS) region of ribosomal DNA (rDNA). PCR amplicons were electrophoresed on 2% agarose gel after digesting by different restriction enzymes including MvaI, HinfI and HaeIII. Among 160 clinical samples examined, 6 dermatophyte species including Trichophyton mentagrophytes, T. ru brum, T. verrucosum, T. tonsurans, Microsporum canis and Epidermophyton floccosum were finally identified based on the col ony morphology and microscopic criteria. Specific PCR products and RFLP patterns for MvaI, HinfI and HaeIII en zymes allowed the rapid identification and reliable differentiation of isolated dermatophytes at the genus or species level for 5-10 day-old colonies. The results showed that PCR-RFLP analysis of the ITS region of rDNA is a rapid and reliable tool which al lows identification of major pathogenic dermatophytes isolated in this study at species level in young 5-10 day-old colonies.

Subtilisin –like proteases are the group of proteases including keratinases found in dermatophytes which de graded keratin. Determination of the proteases activity of Trichophyton vanbreuseghemii isolates which were obtained from soil and clinical and soil isolates of Microsporum gypseum in Iran and characterization of their genome were aim of present study. Ezymatic activity was determined by use of chromogenic substrates. The genes, which coded subtilisin-like pro teases in above-mentioned dermatophytes, was identified and amplified by using specific primers in PCR. The highest yield of enzyme production was observed in only one isolate of T. vanbreuseghemii Ir-84 whereas low enzyme activity was observed in M. gypseum isolates. Homology study of obtained nucleotide as well as amino acid sequences indicated different rates of homology with other subtilisin-like proteases genes in other pathogenic dermato phytes. Intra-strain differences were observed in production of serine proteinases and molecular characterization of genes encoding such enzymes could be of great interest for studies on pathogenicity and other purposes

Hospitals generate relatively large quantities of wastewater that may contain various potentially hazardous ma terials; therefore the proper management of hospital wastewater is essential. In this cross-sectional study, the quality and quantity of wastewater in the hospitals of Tehran University of Medi cal Sciences (TUMS), Tehran, Iran, were studied and the suitable method for wastewater management in the hospitals was determined. Monitoring of pH, TSS, BOD5, COD and total coliforms indicated that the quality of wastewater in the hospitals was similar to domestic wastewater. The wastewater production in the hospitals was determined to be in the range of 398 to 1090 L/d/(occupied bed). The study on wastewater treatment and disposal methods demonstrated that discharge to munici pal wastewater collection system is the best alternative for wastewater management in the hospitals, but this approach is not ap plicable for all of the hospitals. Baharloo, Cancer Institute, Children, Farabi, Imam Khomeini, Razi, Roozbeh, Shariati and Valiasr hospitals can be connected to municipal wastewater collection system at present. It is recommended that these hospitals’ wastewater be discharged to municipal wastewater collection system. Amir Alam, Bahrami, Mirza Koochak Khan and Sina hospitals will be able to discharge their wastewater into sewerage net work at second phase of Tehran sewerage project (in 2010) and Arash Hospital will be able to discharge its wastewater into sew erage network at third phase of Tehran sewerage project (in 2015). These hospitals have to select onsite separate waste water treatment alternative.

Hepatitis B virus (HBV) is one of the major causative agents of acute and chronic liver disease worldwide and is believed to be responsible for a million deaths annually. On the basis of a comparison of complete genomic se quences, HBV has been classified into eight genotypes A-H which show a geographical distribution. Some genotypes are associ ated with different clinical outcomes. Identification of HBV genotypes is important to begin and follow up the treat ment. In this cross-sectional study, the serum samples of blood donors were collected from Tehran Blood Transfusion Cen ters in period during "2005-2006". Sera of 55 blood donors who were positive for hepatitis B surface antigen were se lected. DNA was extracted using commercial kit and the S gene sequence was amplified by nested-PCR. PCR products were then analyzed for restriction enzymes that would be genotype specific. Genotype D was found the only type in all HBV DNA positive serum samples, in Tehran. Genotype D is dominant among Tehran’s blood donors, which is consistent with Iran and the Middle East domi nant genotype.

Due to complex causal framework of neonatal mortality, improvement of this health indicator is quite gradual and it’s decreasing trend is not as great as other health indicators such as infant and under 5 mortality rates.This study was conducted to evaluate neonatal mortality risk factors based on nested case-control design. The study population was 6900 neonates who were born in rural areas of Kohgiluyeh and Boyerahmad province (South of Iran). They were under follow up till the end of neonatal period and the outcome of interest was neonatal death. By using risk set sampling method, 97 cases and 97 controls were selected in study cohort. prematurity (OR= 5.57), LBW (OR= 7.68), C-section (OR= 7.27), birth rank more than 3 (OR=6.95) and birth spac ing less than 24 months (OR=4.65) showed significant statistical association (P< 0.05) with neonatal mortality. The Popula tion Attributable Fraction (PAF) was 0.45 for LBW, 0.40 for prematurity, 0.28 for C-section, 0.30 for birth rank more than 3, and 0.16 for birth spacing less than 24 months. Prematurity, low birth weight, C-section, birth spacing less than 24 months and birth rank more than 3 are impor tant risk factors for neonatal mortality.

Although the issue of hyperuricemia as a risk factor for cardiovascular diseases (CVD) has been disputed, sev eral studies have shown an association between hyperuricemia and several CVD risk factors. The aim of this study was to assess distribution of uric acid level in Yazd City, center of Iran, and its association with CVD risk factors. From autumn 2004 to summer 2005, 2000 urban population of Yazd City, aging 20-74 years via clustering ran dom sampling were enrolled in this cross sectional study. Serum uric acid level, systolic blood pressure (SBP), diastolic blood pressure (DBP) and waist/hip ratio were signifi cantly higher in men than in women (P< 0.001),moreover, total cholesterol, HDL cholesterol and body mass index (BMI) were significantly higher in women (P< 0.001). The prevalence of hyperuricemia and metabolic syndrome in men and women was (17.9%, 11.25% P= 0.001) and (11.87%, 19.32% P= 0.01), respectively. Hyperuricemia was more preva lent in metabolic syndrome and ischemic heart disease independent of age and sex. Significant correlations were found between serum uric acid and several components of the metabolic syn drome. Weight, waist circumstance, triglyceride level and DBP, were the major determinants of the variations in serum uric acid levels. This could be attributed to the insulin resistance status.

The clinical diagnosis of meningitis is crucial, particularly in children. The early diagnosis and empiric an tibi otic treatments have led to a reduction in morbidity and mortality rates. PCR and the enzymatic digestion of 16SrDNA frag ment which is produced by universal primers led up fast and sensitive determination. The purpose of this study was to investi gate a rapid method for detection of common bacterial pathogens causing meningitis. According to the gene encoding 16SrDNA found in all bacteria, a pair of primers was designed. Then the univer sal PCR was performed for bacterial agents of meningitis (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influ enzae, etc.) by employing broad- range DNA extraction method. The ob tained uni versal PCR products were digested with restriction enzymes (HaeIII, AluI and MnlI) to identify bacterial species. By the enzymatic digestion of the universal products of each standard strain of the above bacteria, specific patterns were achieved. These specific patterns may be used for comparison in CSF examination. The analytical sensitivity of the as say was approximately 1.5102 CFU/ml of CSF even in samples with high amount of proteins. The universal PCR coupled with enzymatic digestion can be used to detect and identify bacterial pathogens in clini cal specimens rapidly and accurately. Molecular diagnostic of bacterial meningitis, though expensive and labor-inten sive, but is valuable and critical in patient management.

Seizure is the most common pediatric neurologic disorder. Epidemiological studies of childhood epilepsy are of importance to compare incidence and prevalence rates, age distribution, inheritance, seizure types, epilepsy syn dromes and treatment strategies. Since there is little information about prevalence of childhood seizure in Iran, this study was aimed to determine the life time prevalence of childhood seizure and some of its determining factors in Tehran, Iran. In this cross sectional study, 2500 male and female students, aged 12 years or younger, studying in fifth grade of primary schools in district one of Ministry of Education were assessed by filling a preliminary questionnaire. Those who were categorized by the author as having a history of any form of seizure were assessed by a second questionnaire. The clinical form of seizure, the presumptive cause, positive family history and use of anti-convulsant drugs were recorded. The life time prevalence of seizure was 32/1000 population which was more prevalent in boys. Generalized seizure was the most common clinical form. Approximately 60% of cases reported febrile convulsion as the presumptive cause stated by the physician. Positive family history was reported in 29.6% of cases. Anti epileptic drugs were taken by 54% of students with a positive history of seizure. The results of this study show that the life time prevalence of seizure is relatively high in Iranian community, although the other factors were in concordance with other communities.

Municipal solid waste (MSW) is the natural result of human activities. MSW generation modeling is of prime im portance in designing and programming municipal solid waste management system. This study tests the short-term pre diction of waste generation by artificial neural network (ANN) and principal component-regression analysis. Two forecasting techniques are presented in this paper for prediction of waste generation (WG). One of them, multivari ate linear regression (MLR), is based on principal component analysis (PCA). The other technique is ANN model. For ANN, a feed-forward multi-layer perceptron was considered the best choice for this study. However, in this research af ter removing the problem of multicolinearity of independent variables by PCA, an appropriate model (PCA-MLR) was de veloped for predicting WG. Correlation coefficient (R) and average absolute relative error (AARE) in ANN model obtained as equal to 0.837 and 4.4% respectively. In comparison whit PCA-MLR model (R= 0.445, MARE= 6.6%), ANN model has a better results. How ever, threshold statistic error is done for the both models in the testing stage that the maximum absolute relative error (ARE) for 50% of prediction is 3.7% in ANN model but it is 6.2% for PCA-MLR model. Also we can say that the maxi mum ARE for 90% of prediction in testing step of ANN model is about 8.6% but it is 10.5% for PCA-MLR model. The ANN model has better results in comparison with the PCA-MLR model therefore this model is selected for prediction of WG in Tehran

To find out the knowledge, attitude and compliance with standard precautions among doctors working in a terti ary care hospital. The cross sectional study was conducted during October 2006 in the form of self reporting questionnaire. The question naire included question about duration of clinical experience, Hepatitis B Virus vaccination and its antibody titer, knowl edge and compliance of Centre for Disease Control (CDC) standard precaution guidelines. They were further asked about reasons for non compliance. Total 120 doctors participated in this study which includes 60% interns, 34.2% residents and 5.8% consultants. To tal 95% respondents were vaccinated against Hepatitis B virus but only 27.4% knew their antibody titers. Majority of the doc tors, 52.5% didn’t know any thing about Centres for Disease Control guideline for standard precautions while 40% of the respondent had some idea and only 7.5% knew them well. Among responders 56.7% changed gloves for each patient and only 39.2% washed hand in between examining patients. Most of the doctors 58.3% said they always wear apron while deal ing with patients while 20% wear only when dealing with high risk patients. Protective goggles were not used by any of our respondent. The reasons given for non-compliance included non-availability of protective modalities by 58.3% while 20% were of the opinion that it’s not practical. The knowledge attitude and compliance among doctors towards standard precautions is in-adequate. Availabil ity of supplies and awareness programmes for these standard precautions are recommended for better compliance.

Determination of organic pollutants usually requires extraction of the pollutants from samples, using hazard ous solvent. Solid phase micro-extraction (SPME) is a solvent-free equilibrium extraction method, in which, proper calibra tion can allow quantitative measurements of organic pollutants at a very good sensitivity without the use of any organic sol vent. Because individual VOCs are generally present in urine only at trace levels, a sensitive and accurate determination technique is essential. This study describes the optimization of headspace solid phase micro-extraction (HS-SPME) followed by gas chromatography equipped with flame ionization detector (GC-FID) for xylene in spiked urine. Through this investigation, the parameters affecting the extraction and GC determination of xylene, including extraction time, temperature, desorption temperature, desorption time, salt addition, sample pH, sample volume and sample agitation were studied. An op timized headspace extraction was carried out at 30°C for 6 min in presence of 0.2 gml-1 of NaCl in the sample solution. De sorption of the xylene was carried out for 60 sec. at 250°C. The optimized procedure was also validated with three different pools of spiked urine samples and showed a good reproducibility over six consecutive days as well as six within-day ex periments. In this study, the accuracy, linearity, and detection limits were also determined. The HS-SPME-GC-FID technique provided a relatively simple, convenient, practical procedure, which can be successfully applied for determination of xylene in spiked urine when an occupational exposure monitoring is required.

Echinococcosis is one of the most important helminthic zoonotic diseases in Iran. Intestinal Scraping Tech nique (IST), the traditional method for diagnosis of infection in definitive hosts, has many disadvantages including low susceptibil ity and being expensive, hazardous and laborious. Detection of coproantigens in fecal samples by enzyme-linked immu nosorbent assay (CA-ELISA) is known as a useful tool for intravital mass-screening of definitive host populations. This study was performed to determine the prevalence of Echinococcus spp. infection among canids in Moghan plain, the only area in Iran known as endemic for E. multilocularis. One hundred thirty eight fecal samples were collected from red foxes and domestic dogs in three counties of Moghan plain namely Pars Abad, Bileh Savar and Germi. The samples were examined using an ELISA, designed for the detec tion of Echinococcus-specific coproantigen and the formalin-ether concentration method as well. Totally, out of 138 fecal samples, 27 (21.6%) turned positive for Echinococcus coproantigen. coproantigen was de tected in 16.7% and 27.1% of red foxes and domestic dogs, respectively. Formalin-ether concentration method revealed that 43 (31.2%) of samples harbored at least one parasitic helminth, but Taenia eggs were detected only in 3 fecal samples. Since coproantigen presence reflects current intestinal infection with adult worms, CA-ELISA can be regarded as one of the most useful immunological tools for diagnosis of Echinococcus infection. Besides, the high susceptibility, less expense and rapid ity make it the method of choice for epidemiological surveys in endemic areas of Iran.

Multiple myeloma (MM) is a disease of plasma cells that has fatal consequences. New agents associated with mo lecular targets have prompted clinical investigators to design new treatment strategies initially for advanced MM and later for newly diagnosed MM, with encouraging preliminary results. We devised a project to assess the mechanisms of ac tion of two drugs, Ar senic trioxide (ATO) and Zoledronic acid (Zometa) on Bone marrow mononuclear cells (BMMCs) de rived from patients. Bone marrow samples were collected from 10 patients after receipt of formal consent. BMMCs were collected from samples. In two parallel sets of experiments, BMMCs were treated with 0.5, 2, 6 µM ATO and 0.1, 10, 100 µM Zo meta, for 72 h. The following analyses were then performed on treated cells as compared to untreated cells (assumed as con trol): cytotoxicity using Micro culture tetrazolium test (MTT assay); matrix metalloproteinase-2 zymography; comparative gene expression analysis of IL-6, vascular endothelial growth factor (VEGF) and intercellular adhesion molecule-1 (ICAM-l). MTT assay showed significant proliferation inhibition in ATO high dose treatment (6 uM). However, no signifi cant in hibitory effect of Zometa was seen. Zymography analyses showed significant decrease in gelatinolytic activity in treated cells. Analyses of gene expression using Real-Time RT-PCR methodology showed significant decrease in IL-6, ICAM-1, and VEGF genes as normalized against Hypoxanthine phosphoribosyltransferase normalizer and as compared with untreated cells. Both ATO and Zometa could significantly decrease MM cells critical phenotype and genotype. This finding could support the hypothesis that ATO or Zometa could inhibit growth and metastasis of malignant cells.

Giardia lamblia and Helicobacter pylori are two flagellate microorganisms that grow in duodenum and stom ach. The aim of this study was to evaluate the prevalence of them in patients with dyspepsia and other GI disorders. In this cross-sectional study, co-infection of above-mentioned agents was investigated in a group of 130 patients [me dian age of 40 yr (range=11-79) including 76 males (58.8%)] with dyspepsia using three methods of duodenal aspiration sam ple, duodenal biopsy samples and evaluation of stool samples. From 105 patients (59 males, 46 females, median age 40 years, range 11-79) entering this study from 3 hospitals, 4 patients (3.8%) had G. lamblia and 61 patients (58%) had H. pylori. All 4 patients infected by Giardia had also H. pylori infec tion. Tenesmus (3 out of 4 patients) was the most common symptom in patients with H. pylori infection (48 out of 61 pa tients) was reflux. Other symptoms in patients infected with both organisms (4 patients) included diarrhea (2 cases), weight loss (2 cases), and loss of appetite (1 case) but no report of vomiting. In patients co-infected with Giardia, H.pylori differentiation by physical examination is not possible. So in those patients with positive Rapid Urease Test (RUT), stool examination for Giardia detection is recommended. In addition, met ronidazole (broad spectrum, anti-protozoal drug) can be useful in H. pylori infection.

Trichinellosis is both of veterinary and medical importance in countries where pig breeding and pork consumption exists. In Iran, people are forbidden to consume pork because of the religious regulations. Therefore, there have not been any human cases over the past decades except a doubtful case based on serological test. Although there are some sylvatic trichinellosis in wild life in different parts of Iran, but a little is known about the current prevalence in wild animals. To date, some cases of Trichinella nelsoni in golden jackals from Khuzestan Province; Trichinella spiralis in wild boars, brown bears, golden jack als, jungle cat, from Mazandaran Province and stray dogs, Jackals, red fox, hyena, Meriones percicus in Isfahan; finally T.spiralis nelsoni in Herpestes auropuntatus from Khuzestan were reported. Based on these data and consumption of ani mal derived food products among some local hunters, and not a safe and insure rodent control, trichinellosis could be con cern as an emerging disease, so more investigation and clinical awareness are needed in this regard

Chrysomya bezziana Villeneuve is the most important fly, which produces myiasis, exists as an obligate ectoparasite in the ani mals, and afflicts human. Poor hygiene and working in contaminated areas particularly during warm seasons provide a situa tion to infest by this parasite. Infestation in human and livestock are often observed in wounds, normal body orifices such as eyes, ears, nose, and mouth. The manifestations include pruritus, pain, inflammation, redness, eosinophilia, and secon dary bacterial infections and rarely death. A 5-year-old boy with severe headache and agitation symptoms was fol lowed up. After physical examination and endoscopy, larvae of third instar fly were obtained from his scalp. Our precise identifica tion indicated that the flies were the C. bezziana. This is the second report of the human scalp myiasis caused by C. bezziana in Iran. This study confirmed that the old world screwworm fly was distributed in the southern of Iran and proba bly could be one of the most important agents of myiasis in this area.