International Journal of Preventive Medicine
Volume:5 Issue: 3, Mar 2014

Chronic kidney disease is one of the most common complication of systemic lupus erythematosus, which if untreated can lead to the end-stage renal disease (ESRD). Early diagnosis and adequate treatment of lupus nephritis (LN) is critical to prevent the chronic kidney disease incidence and to reduce the development of ESRD. The treatment of LN has changed significantly over the past decade. In patients with active proliferative LN (Classes III and IV) intravenous methylprednisolone 1 g/m2/day for 1-3 days then prednisone 0.5-1.0 mg/kg/day, tapered to <0.5 mg/kg/day after 10-12 weeks of treatment plus mycophenolate mofetile (MMF) 1.2 g/m2/day for 6 months followed by maintenance lower doses of MMF 1-2 g/day or azathioprine (AZA) 2 mg/kg/day for 3 years have proven to be efficacy and less toxic than cyclophosphamide (CYC) therapy. Patients with membranous LN (Class V) plus diffuse or local proliferative LN (Class III and Class IV) should receive either the standard 6 monthly pulses of CYC (0.5-1 g/m2/month) then every 3 rd month or to a shorter treatment course consisting of 0.5 g/m2 IV CYC every 2 weeks for six doses (total dose 3 g) followed by maintenance therapy with daily AZA (2mg/kg/day) or MMF (0.6 g/m 2/day) for 3 years. Combination of MMF plus rituximab or MMF plus calcineurin inhibitors may be an effective co-therapy for those refractory to induction or maintenance therapies. This report introduces a new treatment algorithm to prevent the development of ESRD in children with LN.

Excess weight may be associated with mental distress and this relationship varies according to the socio-cultural background of different populations. This study aims to assess the relationship of overweight and obesity with some psychological disorders in a nationally representative sample of Iranian adolescents.This nationwide study was conducted in 2009-2010 among 5570 students, aged 10-18 years, living in 27provinces in Iran. Data were collected by using the translated and validated questionnaire of the World Health Organization Global School-based Health Survey.Data of 5528 students (49.7% girls) were complete for this study. Their mean age was 14.7 (2.4) years. Overall 7.9% of participants were overweight and 8.8% were obese. 58.7% of students had anxiety, without significant association of overweight (odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.68-1.09) and obesity (OR: 1.11, 95% CI: 0.88-1.40) with an anxiety. Nearly 62.6% of students reported to have depression, there was no significant relationship between overweight (OR: 1.11, 95% CI: 0.86-1.43) obesity and (OR: 1.01, 95% CI: 0.79-1.29) with the depression. About 49.4% of students had insomnia, without significant association of overweight (OR: 1.17, 95% CI:, 0.91-1.51) and obesity (OR: 0.91, 95% CI: 0.71-1.17) with the insomnia.In Iranian adolescents, excess weight did not increase the risk ofpsychological distress. This finding might be due to the positive attitude of family and peers to fatness in adolescence.

The current study examined race and ethnic differences in the separate and combined (additive) effects of anxiety, depression and problem drinking on the baseline and trajectory of subjective health among adult men in the United States. This longitudinal study used data from the Fragile Families and Child Well-being Study. We included 4655 men, composed of 2407 Blacks, 1354 Hispanic Whites and 894 non-Hispanic Whites. The dependent variable was subjective health, measured four times (i.e., baseline, year 1, year 3 and year 5). Latent growth curve modeling was used for data analysis. When controlling for socio-economics, we tested separate effects of anxiety and depression. Then we tested combined effects of anxiety, depression and problem drinking. Among all race and ethnic groups, anxiety and problem drinking were associated with baseline and associated trajectory of subjective health. Combined (additive) effects of anxiety and depression, however, varied based on race and ethnicity. Among Blacks, depression and anxiety were associated with a worse trajectory of subjective health. Among non-Hispanic Whites, anxiety was associated with a better baseline and worse trajectory of subjective health, while depression was associated with worse baseline subjective health. Among Hispanic Whites, anxiety was associated with a worse trajectory of subjective health, while depression was not associated with subjective health. Although separate effects ofanxiety, and problem drinking were similar among race and ethnic groups, race and ethnicity seemed to modify the combined effects of different mental health problem. These results warrant further exploration of these complex links.

Childhood zinc deficiency is a common problem in many developing countries where people rely mainly on plant based diets with low zinc contents. Zinc supplementation is one of strategies to combat zinc deficiency and its consequences in children. The aim of this community trial was to examine the effect of zinc supplementation on the linear growth of children 6-24 months of age and to examine the feasibility of its implementation in the context of primary health care (PHC).Rural community health centers providing maternal and child care in two areas with moderate rates of malnutrition were randomly assigned to intervention and control groups, including 393 and 445 children 6-24 months of age, respectively. Children in both groups received routine iron and multivitamin or vitamin A and D supplements through PHC services. Mothers of children in the intervention group were asked to give a single dose of 5 ml/day zinc sulfate syrup (containing 5 mg elemental zinc) to their children for 3 months while children in the control group did not receive the supplement.Anthropometric measurements were performed at baseline and on a monthly basis in both groups. We found a 0.5 cm difference in the height increment in the intervention group as compared with the control (P< 0.001). Zinc supplementation had no effect on weight increment of children.Oral zinc supplementation was found to be both practical and effective in increasing linear growth rate of children less than 2 years of age through PHC.

Infection of mothers with Rubella virusduring pregnancy can be serious; if the mother is infected within the first 20 weeks of pregnancy she is likely to have miscarriage, stillbirth, or baby with congenital rubella syndrome. This study was carried out to define Rubella virusseroprevalence in pregnancy in Osogbo, Nigeria.This study is a cross-sectional sero-survey of rubella IgG antibody among pregnant women attending antenatal clinic of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. Socio-demographic information on participants was collected by interviewer-administered questionnaire while venous samples were collected, stored at −20°C and serum samples were screened for detection of rubella IgG antibodies using the enzyme linked immunosorbent assay.Of the 200 sample evaluated for rubella Immunoglobulin G antibody, 175 (87.5%) were positive and 25 (12.5%) were negative. The result indicated prevalence of 85.7% in 15-19 year age group, 86.8% in 20-24 year age group, 89.6% in 25-29 year group, and 100% in greater than 40 year age group. Rubella IgG seroprevalence was not associated with age, gestational age, gravidity, vaccination, occupation and education.As the immunity gap in the studied population was high, rubella vaccination should be provided for all women of child-bearing age and children.

Tramadol poisoning has increased in recent years. Seizure is one ofthe side-effects oftramadol toxicity. There is a controversy about possible preventive effect of naloxone in tramadol poisoning induced seizure. Therefore, this study was performed to compare seizure incidence in tramadol poisoning patients who received and did not receive naloxone, as an opioid antagonist.This study involved prospective data collection followed by retrospective analysis on 104 tramadol poisoning patients who were admitted in a referral poisoning center. The incidences of seizure were compared between patients received naloxone and those did not. Outcome was considered as survived without or with complications and death. Logistic Regression analysis was used to determine the effects of different variables on seizure incidence.70 (67.3%) of the patients were men. The mean age ofthe patients was 26.3 ± 9 years old. 18.3% of the patients received naloxone in their treatment period. Seizure incidence was significantly higher among tramadol poisoning patients who did not receive naloxone compare with those received naloxone (14.1% vs. 5.1%). Among different variable studied, age had a significant effect on predicting of seizure (odds ratio = 2.09; 95% of confidence interval: 1.82-2.26;P value, 0.004).Although the seizure incidence was lower in patients with tramadol poisoning who received naloxone, the logistic regression did not support the preventive effect of naloxone on seizure in tramadol poisoning cases.

The door-to-needle-time (DNT) is considered a standard time for scheduling thrombolysis for acute ST-segment elevation of myocardial infarction and this time can be reduced by minimizing the delay in starting thrombolytic treatment once the patient has reached to the hospital. This study was carried out on a sample of Iranian patients with acute myocardial infarction to determine the DNT in those after changing schedule of thrombolysis during 8 years from emergency to coronary care unit (CCU).A descriptive cross-sectional study was carried out on all consecutive patients with a confirmed diagnosis of acute myocardial infarction admitted to the emergency ward of Ekbatan Hospital in Hamadan, Iran, within 2011 and had an indication of fibrinolytic therapy, which 47 patients were finally indicated to receive streptokinase in the part of CCU.The mean time interval between arrival at the hospital and electrocardiogram (ECG) assessment was 6.30 min, taking ECG and patient’s admission was 21.6 min and transferring the patient from admission to CCU ward was 31.9. The time between transferring the patients to CCU ward and fibrinolytic administration order and the time between its ordering and infusion was 31.2 min and 14.0 min respectively. In sum, the DNT was estimated 84.48 ± 53.00 min ranged 30-325 min that was significantly more than standard DNT (P<0.01). Furthermore, DNT mean in this study is significantly more than a study conducted 8 years ago in the same hospita l (P<0.01).The DNT is higher than the standard level and higher than the estimated level in the past. This shows that DNT was longer after transferring to CCU.

Although intellectual disability (ID) is a common disability in Iran, there is no investigation on the spatial distribution pattern of these patients in national level and the spatial maps for recognition the areas with higher prevalence of IDs and local neighborhoods of these regions or effect of socio-demographic factor on this scattering is not still available. This proposition motivated us to assess the population with ID in our country.In a cross-sectional study, we applied Moran’s Index (Moran’s I) which includes information about the strength of the neighboring association between counties, as global univariate distribution assessment. A geographically weighted regression was used to explore relation between ID patient’s prevalence and some socio-demographic factors (migration and illiteracy rate, physician number (PN)/10,000 people and health-care centers (HCCs)/10,000 people).We found that spatial clusters of ID patients exist among Iran counties (Moran’s I = 0.36,P < 0.01) and in a rural area population groups (Moran’s I = 0.20,P < 0.01). Further, we detected spatial associations between ID patients and all of our investigated socio-demographic factors in national scale. In rural areas, illiteracy has high association with ID especially in the south region of Iran. Urban area has random pattern of ID patients both within and between the Iran counties (Moran’s I = 0.01,P > 0.3).According to the results, our Initial hypothesis about the existence ofspatial clusters in distribution ofpeople with ID in Iran was proven. Spatial autocorrelation between migration and illiteracy rate and prevalence of patients with ID was shown and was in agreement with our hypothesis. However, our supposition that the prevalence should have inverse relationship with PN and HCC was rejected.

Physicians constitute a considerable professional influential group; they may be most suited for tobacco use prevention and smoking cessation intervention among the growing tobacco using population.We assessed tobacco cessation knowledge and practice done by 91 physicians in two blocks of Khurda district by using modified version of survey instrument developed by Francisco G. Soto Mas. Statistical Package for Social Sciences (SPSS) 16 statistical software was used for the analysis.The response rate was 75.83%, of which 77 (84.6%) were male. Study participants were in the age group 36-45 years. Nearly 13.2% of the respondents were active tobacco user. In tobacco-related practices, around 58 (62%) of participant physicians ask patients about tobacco use status always-frequently. More than (67) 70% of participant physicians advise their patients to quit tobacco but only 10-20% of study physicians assist them in referring to cessation programs. Seventy one (78%) of physicians felt providing counseling to patients using tobacco as their responsibility.The results indicate that physicians participating in this study do not meet the level ofintervention recommended by National Tobacco Control Program.

We determined the blood lipid-lowering effects ofeicosapentaenoic acid (EPA) on hypertriglyceridemic subjects with Leu162/Val in exon 5 and G/C in intron7 polymorphism of peroxisome proliferator-activated receptor alpha (PPARα)genotypes that, to our knowledge, have not been previously studied. A total of170 hypertriglyceridemic subjects were enrolled and genotyped for Ala54Thr, Leu162Val, and intron7 polymorphism by the use of a polymerase chain reaction restriction fragment length polymorphism method. After determination of their genotypes, the first 23 eligible subjects who were found as Ala54 carriers and the first 23 eligible Thr54 carriers were enrolled in the study and stratified for PPARαgenotypes. Participants took 2 g of pure EPA daily for 8 weeks. Fasting blood lipid and lipoprotein profiles were determined and changes from baseline were measured. We observed significant difference between EPA supplementation and Leu162 and Val162, Interon 7 (GG and GC) carriers (P < 0.001). We did not observe significant associations between the PPARαL162V single nucleotide polymorphism and multiple lipid and lipoprotein measures. Although EPA consumption lowered lipid and lipoprotein concentrations in Leu162 and Val162 carriers and Interon 7 CC and GC carriers, these differences between the studied groups were not statistically significant. EPA consumption has a lipid-lowering effect in hypertriglyceridemic subjects in both Leu162 and Val162 carriers. But there was no significant interaction between EPA supplementation and PPARαgenotypes. Thus, genetic variation within the PPARαLeu162/Val cannot modulate the association of EPA intakes with lipid and lipoprotein profile. However, we must note that the sample size in this study was small.

The first step in diagnosis of diabetic nephropathy is measurement ofalbumin in a spot urine sample. The aim of this study was assessment of the accuracy of urinary albumin to creatinine ratio (UACR) in random urine specimens (RUS) for microalbuminuria and macroalbuminuria screening in Iranian diabetic patients.A total of 200 diabetic patients participated to our study. 24 h timed urine specimens followed by RUS were collected. 24-h urine albumin excretion (24-h urinary albumin excretion (UAE)) and UACR in RUS were measured. Data were analyzed by Pearson’s correlation, receiver operating characteristic (ROC) curve and McNemar test.A total of 165 patients finalized the study. Pearson’s correlation ofcoefficient for 24-h UAE versus UACR was 0.64. The area under ROC curve for UACR was 0.83 in microalbuminuria and 0.91 in macroalbuminuria. The cutoff point of 30 mg/g in UACR method had 86% sensitivity and 60% specificity for microalbuminuria screening and cut-off point of 300 mg/g had 75% sensitivity and 99% specificity for macroalbuminuria screening respectively.UACR in RUS showed acceptable performance as a screening test for diagnosis ofboth micro and macroalbuminuria in Iranian diabetic patients.

Growth is one of the most important indices in child health. The best and most effective way to investigate child health is measuring the physical growth indices such as weight, height and head circumference. Among these measures, weight growth is the simplest and the most effective way to determine child growth status. Weight trend at a given age is the result of cumulative growth experience, whereas growth velocity represents what is happening at the time.This longitudinal study was conducted among 606 children repeatedly measured from birth until 2 years of age. We used linear mixed model to analyze repeated measures and to determine factors affecting the growth trajectory. LOWESS smooth curve was used to draw velocity curves.Gender, child rank, birth status and feeding mode had a significant effect on weight trajectory. Boys had higher weight during the study. Infants with exclusive breast feeding had higher weight than other infants. Boys had higher growth velocity up to age 6 month. Breast fed infants had higher growth velocity up to 6 month, but thereafter the velocity was higher in other infants.Many of the studies have investigated child growth, but most of them used cross‑sectional design. In this study, we used longitudinal method to determine effective factors on weight trend in children from birth until 2‑year‑old. The effects of perinatal factors on further growth should be considered for prevention of growth disorders and their late complications.

Celiac disease is an autoimmune disorder that affected 1% of all population in United State. Classic manifestations ofdisease consist of early childhood diarrhea, malabsorption, steatorrhea and growth retardation but disease can affects adult at any age. In adult anemia is a more frequent finding. This patient was a 40-year-old lady with progressive fatigue and lower extremities pitting edema. Iron deficiency anemia and celiac disease were diagnosed on the basis of low serum ferritin, elevated serum level of IgA endomysial and tissue transglutaminase anti-bodies and histologic findings in small bowel biopsies. Pericardial effusion in her evaluation was detected incidentally. Asymptomatic pericardial effusion in this patient was only detectable with imaging. After starting of gluten free diet and iron supplement fatigue, peripheral edema and pericardial effusion on echocardiography decreased. It should be noted that asymptomatic pericardial effusion may be seen in adults with celiac disease.

The different duration of delay to first contact with a psychiatrist in depressive disordered patients has been observed in western and non western cultures. This study aimed to examine the duration and predictive factors of delay in contact with a psychiatrist in depressive patients in Isfahan city of Iran.In This cross sectional study 156 depressive patients were recruited from various outpatient clinics in Isfahan city between January 2013 and February 2013. We used the Anderson Socio-Behavioral Model (ASBM) for examine the role of various factors influencing delay in help seeking. In this models there were three categories variables (predisposing, enabling and need factors). Quintile regression model was used to study the predictors. Potential predictors were entered in this model in four steps. Predisposing factors in the first step, Enabling factors in the second step, Need factors in the third step and in the last step, all the factors were entered.the median duration between symptom onset and first contact with a psychiatrist was 1 year. In the first step (predisposing model), age at onset of depressive symptoms and never married were negative predictors for delay, but widowed or divorced statues was positive predictors for delay. In the enabling model past contact with health provider was positively associated with duration of delay. In the need model, neither variable had a significant effect on duration of delay. In the full model, younger age at onset, widowed or divorced statues and past contact with health provider increased duration of delay.More delay of help seeking by children and adolescence and probability ofmaladaptive coping style such as substance use and complicating of situation need to earlier diagnosis of depression in young group and earlier treatment for decrease DALLY for MDD, Therefore we suggest the mental health awareness programs for adolescent in school, and more ever for the influenced roles of parent and other family members and teachers on teen and young person’s life, the education for families and teachers on adolescent mental health problems canbe effective. First help seeking contact with nonpsychiatric medical professionals enhance the delay of contact with a psychiatrist. Appropriate training of non-psychiatric medical professionals and developing a referral system would lead to better provision of mental health care.

Premarital counseling equips couples with information about all aspects ofsexuality and the related health issues. This study was aimed to assess the quality of premarital counseling services in health care centers in Tabriz. A cross-sectional study was conducted on 236 randomly selected women from premarital counseling centers in Tabriz was carried out and a self-structured instrument including items on demographic characteristics, the quality of counseling condition and providers, family planning, genetic and thalassemia counseling and sexual health was used for data gathering.The results showed that the viewpoint of clients about relationship with health care provider and condition ofconsultation was suitable in 75.8% and 85.2% of women, respectively. It was found that in 72.5%, 38.1% and 49.6% of clients the counseling areas were in moderate level respectively for counseling about importance of family planning, genetic counseling and thalassemia. It was indicated that 58.5% of participants expressed the sexual health aspect of the premarital classes as poor or completely poor.Our study results can provide suitable information for health policy providers to improve the quality of premarital counseling classes. In order to develop a relatively stable behavior in young couples, it is recommended that the quality of the classes would be overemphasized.