فصلنامه کومش
سال چهاردهم شماره 1 (پیاپی 45، پاییز 1391)

Weight loss in children is one of the health problems that could occur several times for a child; therefore it is categorized as a recurrent event. In this study, we investigated the weight loss risk factors firstly by using proportional rates model and then by applying time-dependent coefficient rates model. In this study, the information of 1673 babies who were born in 2006 or 2007 and were visited for monthly check ups at Tehran east health centers during their first two years of life were included in the analysis. We first fitted the standard proportional rates model to this data with the purpose of determining weigh loss major risk factors. After adjusting these factors, the month-specific effect of complementary foods on weight loss occurrence rate was explored using time-varying coefficient rates model. Our findings showed that the risk of weight loss gets heightened as with the increase in the intake of complementary foods. This negative effect is likely to be the most between 9 and 11 months of age and then tends to weaken as the baby grows older. The results of Wald-type statistic showed that the impact of complementary food on the occurrence of weight loss is significantly different with respect to the child ‘age (P<0.001). Considering the variability of the effect of complementary food on the occurrence of weight loss, time-varying coefficient rates model can give more appropriate estimation of this effect than proportional rates model.

Obstructive coronary diseases have been found to be the most important for the assessment of cardiovascular diseases. This survey was designed to determine the relationship between ischemic risk factors and tract disease coronary artery. This cross-sectional study was conducted on 5442 patients who referred to Golestan’s Kosar center for angiography in the years 2008 to 2009. The outcome variable was the results of angiography, positive or negative. Risk factors including age, gender, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), blood pressure, diabetes mellitus, smoking and drug addiction in the samples were evaluated and recorded for all patients. Multivariate analysis was performed by logistic regression. We found significant differences between age, diabetic mellitus and hypertension status in patients with positive coronary angiogram versus patient with negative coronary angiogram in both sexes. Also, regression analysis showed hypertension (OR=1.8), abnormal fasting blood sugar (OR=1.2), male gender (OR=2.2), WHR (OR=1.4) and opiates addiction (OR=1.3) increased significantly the probability of coronary arteries involvement. In patients with positive coronary angiogram, fasting blood sugar, hypertension and age in both sexes, and WHR and opium addiction in females may be stronger predictors of extent of CAD. Prevention of these risk factors may be effective in controlling the progress of CAD

Leukemia is the most prevalent cancer among children that its survival rate varies in different parts of the world. The aim of the present study was to estimate five-year survival rate of acute pediatric leukemia including acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML) and then to reveal its determinants among a group of 15 years old children visiting Shiraz ShahidFaghihi hospital from 2004 to 2008.

In a retrospective cohort study, to measure survival rate, all of the diagnosed patients with ALL and MLL (280 patients) were entered into analysis. The required data were obtained from patients registered files. To conduct analyses, Kaplan-Meyer and ordinal logarithm methods were used. Modeling of data was undertaken using by SPSS software and Cox regression method.

The average follow-up period was about 28.2±16.1 months (range: 6.4-67.4) during which 60 patients (24.7%) (47 ALL cases and 15 MLL cases) passed away. Cumulative five-year survival rate was estimated to be 53.3±0.055 percent. Cox regression model revealed that there was a significant relationship between Platelet count and number of elapses with leukemia survival rate.

Our study showed that platelet count and number of relapses are effective factors on leukemia patient's survival. Thus, to extend the survival of these patients, these factors should be counted on.

As quadriceps (QC) and hamstring (H) work functionally in concentric and eccentric contraction pattern in the activities of daily living, it is necessary to evaluate functional H/Q ratio. The functional Hamstring/Quadriceps ratio (H/Q ratio) has not been investigated in the patients with knee osteoarthritis (OA). Therefore, we compared functional and conventional H/Q ratio in patients with knee osteoarthritis. Thirty five patients with knee OA (21 females and 14 males 45-70 years old) were participated in this cross sectional study. Maximum torque of QC and H were evaluated during concentric and eccentric contraction (at 30°/s, 60°/s and 90°/s) and isometric contraction (at 30°,60° and 90° of knee flexion). Conventional H/Q ratio was calculated by maximum torque of H concentric or isometric contractions divided by maximum torque of QC concentric or isometric contractions. Functional H/Q ratio was calculated by maximum torque of H eccentric contraction divided by maximum torque of QC concentric contraction. The findings indicated that conventional H/Q ratio in compared with the functional H/Q ratio in lower angular velocity did not show significant difference statistically while this difference was significant in higher angular velocity. Higher significantly functional H/Q ratio was found in higher angular velocity (P< 0.005). Considering that the daily activities and exercise therapy in patients with knee osteoarthritis are doing in lower velocity, not only the strengthening of quadriceps muscle but also quadriceps and Hamstring muscles balance should be noticed in exercise therapy of these patients. Also our findings showed functional H/Q ratio increased in higher angular velocity in patients with knee OA like normal subjects.

Epilepsy is a common neurological disorder that may last a lifetime and will require regular medical care. To examine the factors affecting the occurrence of seizures and i nterictal epileptiform discharge (IED) in epileptic patients with considering the correlation between them and also because of the lack of similar studies in this field made the necessity of performing this research. Data were recorded from 97 epileptic patients referred to Shafa Neuroscience Center between 2007 and 2010. Data analysis was performed using shared random effect model. Software used for data analysis was SAS 9.2, and significance level was regarded as 0.05. Among the factors of gender, seizure type, war wounded and duration of epilepsy, only two factors had jointly statistically significant effect; Duration of epilepsy on IED (p<.020) and war wounded on seizure occurrence (p<.002). Odds of Seizures occurred for wars wounded are approximately 11 times more than the odds of other patient. One year increasing on duration of epilepsy resulted in 2.5% increase in IED mean. Since there was a correlation between IED and seizure occurrence, analyzing these data with joint model is proposed. War wounded and duration of epilepsy affected on seizure occurrence and IED, respectively. These covariates should be considered for epilepsy treatment

Catheter related infection is one of the most important complications of vascular access devices. Treatment of these complications is important and life saving. The most common causative organisms are gram-positive bacteria especially staphylococcus. Vancomycin and teicoplanin are two antibiotics which widely used for invasive beta-lactam-resistant Gram-positive infections. In this study, we aimed to compare efficacy of vancomycin and teicoplanin in treatment of catheter related infection. In this clinical trial, 43 patients with catheter infection were enrolled. Diagnosis was based on clinical criteria. 22 patients were received teicoplanin 800mg intra-venous loading dose and 400mg at days 2th, 3th,5th,12th,19th and 21 patients received vancomycin 1gr intra venous loading dose and 500mg every 5 days and for 3 weeks. A criterion for treatment response was absence of fever after 72 hours. %57.1 patients who received vancomycin and %68.2 patients who received teicoplanin had clinical response (p=0.454). In patients who received vancomycin, one case developed red man syndrome and one case developed diarrhea (9.5%) and in tiecoplanin group one patient developed rash (9.1%). Our findings show that there is no significant difference between two groups in treatment of catheter related infection in hemodialysis patients

A longitudinal study involves repeated observations of the same items over long periods of time. Panel studies are longitudinal studies of batch which combine cross-sectional and time- series data in observations on a number of over time that play special role in medical research or clinical trials. In this paper, we primarily discuss about the panel data and various modeling of panel data. It is not possible to use ordinary regression methods due to inter- correlation of observation related to one unit. Generalized estimation equation (GEE) for estimation of panel regression coefficient by considering inter correlation was used among observations.

We considerd the importance of panel data modeling with GEE in real panel data samples as applications in the effect of estrogen patches on the postnatal depression.

In the estimation of panel regression coefficients on real data, starting treatment effect (b(pre)=0.428, p<0.001), treatment group effect (b(group)=4.025, p<0.001) and treatment period effect (b(visit)=1.218,p<0.001 with use of robust method to misspecification of the correlation structure were significant.

According to the important role of panel data inter- correlation structure in analyzing in medical research, we propose to estimate the coefficients of panel via GEE method.

Gastric cancer is the second most common cancer after lung cancer and the leading cause of cancer mortality. Gastric cancer of the lining of the stomach gradually affects the adjacent layers of stomach and spreads out. With studying the characteristics of these patients and determining factors in predicting affecting survival, it may be possible to predict or to improve their survival. In this study, 199 patients with metastatic gastric cancer were studied and the age at the time of diagnosis, type of treatment, degree of tumor differentiation, the number of sites involved and many other factors affecting the length of survival time of patients were evaluated. For data analysis, Kaplan-Meier and Cox proportional hazards model were used. 151 patients (75.9%) were male and 71 patients (35.7%) died in the end of follow-up. The mean and median survival time of patients was 24.7±3.9 and 19 months, respectively. Survival probability of one, three and five year of patients were 0.66, 0.19 and 0.06, respectively. Fitted model showed that age at diagnosis and level of hemoglobin associated with survival in patients with metastatic gastric cancers (P<0.05). With early diagnosis in patients with gastric cancer, risk can be greatly reduced.

Based on both animal and human studies, inequality and social injustice have adverse effects on individual and community health. However, it is not yet known whether social instability and food inequality can cause the premature aging hepatocytes death in young people. To address this question, the effects of food intake inequality with or without unstable social status were evaluated and histopathological changes in hepatocytes and aging process investigated as well. Forty eight Newzeland white male rabbits were divided into six groups and different social situations were applied to some groups during eight weeks. After the end of the period of the experiment, lipofuscin accumulation and apoptosis as two main markers of aging were studied by long Zeihl Nelseen staining and the terminal deoxynucleotidyl transferase dUTP nike end labeling (TUNEL reaction) of the hepatocytes respectively. Serum cortisol level was also measured. The simultaneous application of the mentioned situations (i.e. food restriction, social inequality and changed cage-mate), caused significant change in lipofuscin accumulation in the hepatocytes in comparison with the control group (p<0.001). In addition, application of instability and isolation environment produced significant changes in hepatocytes apoptosis (p<0.05). Accumulation of two main markers of aging increased in hepatocytes and was accelerated in the groups with unstable social status

Metabolic syndrome is a collection of metabolic disorders that increase the risk of cardiovascular diseases (CVD) and diabetes. Metabolic syndrome is characterized by abdominal obesity, hypertriglyceridemia, low HDL level, hyperglycemia and HTN. With regard to the development of CVD disease in recent years, the present study was completed to determine the degree of metabolic syndrome prevalence in the adult population of Semnan province.

This epidemiological cross-sectional study was carried out in the province of Semnan (Iran) on 3799 individuals between 30 and 70 years of age. In the study, multi-stage individuals were randomly selected from urban and rural environments and the prevalence of metabolic syndrome was determined according to ATPIII and IDF criteria.

The prevalence of metabolic syndrome according to ATPIII and IDF was 28.5% and 35.8% respectively, and increased with age in both sexes. The highest degree of prevalence was seen in the above-60-years age group. The Prevalence of metabolic syndrome was significantly higher in women on basis of both definitions; it was higher among non-smokers on basis of the IDF definition (P<0.05). Decrease in the prevalence of the syndrome had significant relation to literacy. There was no significant difference of metabolic syndrome prevalence between urban and rural settings. Among the risk factors of metabolic syndrome according to ATPIII and IDF, high triglycerides (40.8%) and abdominal obesity (70.8%) had the highest prevalence respectively.

The findings show the high prevalence of metabolic syndrome in the 30 to 70 year-old population. Therefore, the identification of the risk factors should be attempted to prevent syndrome acquisition.

According to the importance of head alignment in general posture, it seems that deviation of head from neutral position can affect complex postural and equilibrium control. The purpose of this study was to survey the relationship between forward head posture and balance parameters.

Twenty females (mean age 20.36 years) with forward head posture and Twenty healthy subjects without forward head posture (mean age 21.47 years) were placed in two groups. The degree of forward head posture was measured using plumb line and the cranio-vertebral angle in both sitting and standing postures. Balance tests were performed on a force platform under conditions of double and single leg stance, eyes open and closed on foam and rigid surfaces. Parameters calculated from center of pressure data were standard deviation of displacement and velocity in both anterior-posterior and medio-lateral directions, mean total velocity, standard deviation of total displacement and velocity.

The cranio-vertebral angle showed a significant difference between two groups in both sitting and standing postures (P<0.001). Women with forward head posture have more center of pressure displacement and velocity than women without postural deviations (P<0.05).

Forward head posture can affect postural control and lead to motor control impairment. This balance impairment gets obvious especially in conditions that postural control will be challenged

The main goal of this study was to investigate the capability of regenerated rice husk silica after saturation to remove Hydrogen sulfide (H2S). For this purpose, rice husk silica and regenerated rice husk silica were used as adsorbents bed in filter. A poly vinyl chloride filter with one liter of prepared bed was tested. Rice husk silica was prepared in a furnace at temperature of 800 ºC for Four hours, after acid leaching. Saturated rice husk silica was regenerated in a furnace at temperature of 800 ºC for Four hours too. Removal efficiency, elimination capacity, and pressure drop were the three parameters to evaluate the filters bed. System were operated with empty bed residence time of 60 s and different inlet concentration of H2S from 10 to 300 part per million (ppm). More than 98% of removal efficiency was observed for both packed filters at inlet concentrations of H2S. The maximum elimination capacity was 7.02 gm-3h-1 with H2S mass loading rate of 9.0 gm-3h-1 in the both beds. This study showed that at a 1.0 lmin-1 flow rate and different concentration of inlet H2S. There is no significant difference between the rice husk silica and the regenerated rice husk silica beds in the amount of removal efficiency (p< 0.01). Also, there is no significant difference between these two beds in the amount of elimination capacity at the same condition (p< 0.01). Moreover, this study showed that the amount of pressure drop was undetectable (zero) in both filter’s bed. The results of this study showed the regenerated rice husk silica has the same performance of the primary rice husk silica, Therefore it can be considered as a suitable and inexpensive bed to remove H2S at low concentration.

Hepatitis B virus (HBV) is one of the most important causative agents of chronic hepatic diseases worldwide. Along with viral and immunological components, host genetic background including single nucleotide polymorphisms (SNPs) has a critical role on chronicity or clearance of infection. Programmed cell death 1 is an inhibitory receptor which is expressed on virus-specific T cells and impairs the T cell response in chronic viral infections. In this research the relationship between a single nucleotide polymorphism of exon 5 of the programmed cell death 1 gene (PD1) and susceptibility to chronic hepatitis B infection in an Iranian population has been studied.

In such case-control study, genomic DNA from 160 chronic HBV patients and 150 healthy controls was extracted and genotyping was performed by PCR-RFLP method.

Frequencies of TT, CT and CC genotypes of single nucleotide polymorphism on position 7785 of the exon 5 of PD1 gene were %12.5, %40 and %47.5 in patient group and %10.7, %42.7 and %46.6 in control group, respectively. No statistically significant difference was seen between case and control groups (p value: 0.832).

Although in later studies the relationship between this SNP and susceptibility to some immunological disorders such as rheumatoid arthritis was observed, results of this study suggest that there is no association between PD1 exon 5 C/T single nucleotide polymorphism and susceptibility to chronic hepatitis B in the Iranian population

Vaspin (visceral adipose tissue-derived serine protease inhibitor) has been recently identified as a novel adipocytokine with insulin-sensitizing effects. There is a limited information available regarding the effect of exercise training on serum vaspin concentration. The purpose of this study was to investigate the effect of resistance training on serum vaspin levels and some inflammatory markers. Sixteen male Wister rats (288 ± 19g) were randomly divided into experimental and control groups. The experimental group was subjected to a resistance training program with the use of a ladder (3 days/wk, for 4 wk). Body weight and fasting serum levels of glucose, insulin, vaspin, C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-α were measured. following four weeks resistance training, serum vaspin level was significantly lower in the experimental group than the control group (P< 0.05). The resistance training significantly decreased serum levels of IL-6, CRP and TNF-α in the experimental group as compared to the control group (P< 0.05). This study indicated that resistance training could decrease serum vaspin levels as well as inflammatory markers concentrations. Decreased of serum vaspin levels may be an adjustment mechanism in response to insulin sensitizing improvement and decline of inflammatory markers levels in trained rats.

Ferula persica (F. persica) have been used as lowering blood pressure (BP) in traditional medicine, but its therapeutic effects are not yet known in new medicine. So, in this study, the acute and chronic effects of F.persica aqueous extract were investigated on normal BP of rats. In this experimental study, 40 male wistar rats (250-300gr) were randomly divided to four acute groups (n=7). Femoral artery and vein was catheterized for BP recording and extract or vehicle injected in pentobarbital sodium anesthetized rats. To evaluate chronic extract of F.persica effects on BP, the F.persica extract (30 mg/kg/day) or vehicle was orally administrated in two groups (n=6) for a month. Systolic BP was recorded non-invasively from the tail at the beginning and the end of the experiment. Intravenous administration of aqueous F. persica extract with 15, 30 or 60 mg/kg dosage significantly reduced mean arterial BP of anesthetized rats by 32%, 42% and 55% respectively (p<0.001). Chronic oral administration of extract or vehicle for a month had no effect on systolic BP of conscious rats. Also there is no significant difference in heart rate in different experimental groups. The results of this study showed that intravenous injection of aqueous F. persica extract reduces BP. So, plant component identification and it can be used for hypertensive patients

Pain is a common phenomenon after all surgical operation. Although using analgesia is usual to relieve pain, its complication, unavailability, necessity of taking less drug, especially analgesia, and also ineffectiveness of using analgesia alone, to relieve pain has focused therapeutic system on complementary treatments such as foot reflexology. Therefore, this study was performed to investigate the effects of foot reflexology on pain in patients who underwent cesarean section. This clinical trial study was carried out on 62 women referring to cesarean section in Alzahra Hospital (Rasht city). They were randomly divided into two groups of case and control. The reflexology group was received a 30-minute foot massage in two sessions, with 24-hours interval. Data gathering tool included a demographic form, step-visual analogue scale and pain score form. In the case group, severity of pain after first stage (day one) was significantly lower than before reflexology session and the control group (p<0.001, p<0.0001, repectively). The severity of pain after second stage was significantly reduced in the case group in comparison with the control group (P<0.001). In the case group, physiologic parameters (systolic and diastolic blood pressure, pulse rate and respiration rate) showed no significant differences assumed with the control group. In general, foot reflexology appears to be a useful method to reduce postoperative pain, but no effect on physiological parameters