Iranian Journal of Public Health
Volume:44 Issue: 3, Mar 2015

Cutaneous leishmaniasis (CL) remains a serious public health concern in Kerman Province, eastern Iran. This study was aimed to conduct a comprehensive review and highlights various aspects of CL in the province of Kerman. This article mainly focuses on the studies published in the past 26 years on CL in the province. Current data for the present status were obtained through the provincial health system. Bam was the most infected district (63.6%), followed by Kerman (24.7%) and other districts to a less extent. Leishmania tropica is the major causative agent (95.5%) of CL in Kerman province, however, L. major accounts for 4.5% of the total cases. Bam, Kerman and southern districts of Kerman province were purely anthroponotic CL (ACL), while Rafsanjan, Baft, and Sirjan showed both ACL and zoonotic CL (ZCL). In contrast, Orzoieh district was merely endemic to ZCL type. Phlebotomus sergenti was the main vector in ACL foci while Ph. papatasi was the major vector in the ZCL district of Orzoieh. Localized CL was the most prevalent form (80%) of the disease, while leishmaniasis recidivans was the most uncommon clinical manifestation (18.7%). Due to recent rises in CL disease both in regard of increases in incidence rate and expansion of the disease to new foci, and presence of various risk factors in the province, control measures and health strategies should have high priorities to help treat the existing cases and prevent the expansion of the disease to new areas.

This study examined hearing loss prevalence and hearing aid usage rates among Korean elders by comparing the differences between those with and without hearing loss, and between those who used and did not use hearing aids. This study was based on data collected during the Korean National Health and Nutrition Examination Survey V (2010–2012). The study sample consisted of 5,447 Koreans aged ≥60 years who received a hearing assessment. Hearing loss was measured using a pure tone audiometry test and classified according to the World Health Organization’s criteria. Hearing aid use was assessed by self-report. Multiple logistic regression analyses were performed to determine the associations between hearing loss, hearing aid use, and related variables. Hearing loss was found in 16.8% of the elders and only 15.9% of them used a hearing aid. Male (95% CI: 1.27–2.15), tinnitus (95% CI: 1.58–2.32), dizziness (95% CI: 1.05–1.73), and occupational noise exposure (95% CI: 1.32–2.38) were the variables most strongly associated with hearing loss after multivariate adjustment. Tinnitus (95% CI: 1.34–4.13) and occupational noise exposure (95% CI: 1.01–5.02) were strongly associated with hearing aid use after multivariate adjustment. More than half of South Korean elders aged ≥60 and older have hearing loss but the rate of hearing aid use is very low. An aural public health program should address modifiable risk factors, such as tinnitus and noise exposure, and non-modifiable risk factors associated with hearing loss in the elderly.

Metabolic diseases in China have been on the rise in recent decades, partially due to reduced cereal consumption and excessive intake of low glycemic index (GI) foods such as meat and oil. Although the relationship between dietary glycemic load (GL) and various metabolic diseases has been extensively studied worldwide, it is unclear whether dietary GL is related to blood lipid levels and dyslipidemia risk in Chinese. The aim of the present study was to investigate the relationship between dietary GL and blood lipid levels and dyslipidemia risk in hospitalized Chinese adults. Dietary GL in 2258 hospitalized Chinese adults was calculated based upon GI, carbohydrate content and daily intake of individual foods. In addition, fasting total cholesterol (TC), triglycerides (TG), HDL cholesterol (HDL-C) and LDL cholesterol (LDL-C) data were collected. Multiple regression and logistic regression analysis were used to determine the relationship between dietary GL and plasma lipid levels or dyslipidemia risk. Dietary GL remained inversely associated with blood total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) (P<0.01). With increasing dietary GL, risks of hypercholesterolemia and high blood LDL-C were significantly reduced (P<0.01). In the meantime dietary GL remained negatively associated with blood triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) (P<0.01), but showed no significant influence on risk of hypertriglyceridemia and low blood HDL-C (P>0.05). High GL diet, as represented by traditional Chinese dietary pattern, may contribute to reduced risk of dyslipidemia in Chinese adults.

An experimental study was accomplished to compare estimation methods of ionizing radiations genotoxicity in mammalian cell cultures by means of two cytogenetic parameters with focus on aberrant cells characterized by multiple chromosomal damages. In vitro study was carried out on the genotoxicity of low-medium doses of 190 kV X-rays absorbed in Chinese hamster ovary cell cultures. Micronuclei and ten types of chromosomal aberrations were identified with Giemsa dying and optical microscope screening. The first parameter consisting in micronuclei relative frequency has led to higher linear correlation coefficient than the second one consistent with chromosomal aberrations relative frequency. However, the latter parameter estimated as the sum of all chromosomal aberrations appeared to be more sensitive to radiation dose increasing in the studied dose range, from 0 to 3 Gy. The number of micronuclei occurring simultaneously in a single cell was not higher than 3, while the number of chromosomal aberrations observed in the same cell reached the value of 5 for doses over 1 Gy. Polynomial dose-response curves were evidenced for cells with Ni micronuclei (i=1,3) while non-monotonic curves were evidenced through detailed analysis of aberrant cells with Ni chromosomal changes () - in concordance with in vitro studies from literature. The investigation could be important for public health issues where micronucleus screening is routinely applied but also for research purposes where various chromosomal aberrations could be of particular interest.

Limited studies have examined the relationship between quality of life and lifestyle behaviors. The purpose of this study is to examine the perceptions of quality of life among young Iranian women and its association with lifestyle behaviors. This cross-sectional study was conducted among 391 young women selected through a cluster convenience sampling strategy in Shiraz, Iran. WHOQoL-BREF and satisfaction with life scales were used to measure subjective well-being. The International Health and Behavior survey was used for measuring lifestyle behaviors. Young Iranian women were averagely dissatisfied with their life circumstances. The score of psychological quality of life, and social quality of life were below average. According to the findings, higher quality of life is positively related to healthier lifestyle behaviors. Multiple regression analysis showed that smoking and physical activity are the main predictors of quality of life. Findings also demonstrate that diminished quality of life was significantly associated with older age, low income, being single, low level of religiosity, smoking and low levels of physical activity. In order to improve the situation of young Iranian women, the findings that should be sources of concern to policy makers include the average dissatisfaction with circumstances of life particularly in terms of psychological, social and environmental quality of life. While the health system focus is often upon addressing unhealthy lifestyle behaviors, policy initiatives aimed at improving these circumstances of life for young Iranian women would be of substantial medium to long-term benefit to their wellbeing.

Although theoretically peace affects health, few published evidence for such an association was empirically available. This study aimed to explore the association between peace and life expectancy (LE) among the world countries. In an ecological study and using random effects regression model, we examined the association between peace and LE among world countries between 2007 and 2012. The LE at birth and global peace index (GPI: a score between 1 and 5, higher score means lower peace) were selected as outcome and main predictor variables, respectively. We adjusted their association for the gross national income (GNI) per capita and education index (EI). Data were obtained from the Institute for Economics and Peace (IEP) and UNDP (United Nations Development Programme (UNDP). Numbers of included countries were 158 based on the available data. GPI had a negative, considerable, and statistically significant effect on LE (standardized coefficient -0.039; 95% CI: -0.058, -0.019). This association was also significant even after the adjustment for EI (-0.019; 95% CI: -0.035, -0.003), GNI (-0.035; 95% CI: -0.055, -0.015), and both EI and GNI (-0.017; 95% CI: -0.033, -0.001). The full model showed that around 0.61 of the variation of LE among countries may be explained by the GPI, EI and GNI per capita. The contribution of peace as a global determinant of LE was empirically considerable even after the adjustment for the economic and education levels of countries. This implies that governments should make efforts to settle peace through implementing good governance based on interactions with both public and other countries.

Our aim was to make right and informative decision about choosing the most cost-effectiveness heterogeneous infectious waste treatment methods and devices. In this descriptive study, decision tree analysis, with 10-yr time horizon in bottom-up approach was used to estimate the costs and effectiveness criteria of the employed devices at provider perspective in Iranian hospitals. We used the one-way and scenario sensitivity analysis to measure the effects of variables with uncertainty. The resources of data were national Environmental and Occupational Health Center Survey (EOHCS) in 2012, field observation and completing questionnaire by relevant authorities in mentioned centers. Devices called Saray 2, Autoclave based, and Newster 10, Hydroclave based, with 92032.4 () and 6786322.9 () Dollars had the lowest and highest costs respectively in studied time period and given the 5-10% discount rate. Depending on effectiveness factor type, Newster 10 with Ecodas products and Saray products respectively had the highest and lowest effectiveness. In most considered scenarios, Caspian-Alborz device was the most cost-effectiveness alternative, so for the treatment of each adjusted unit of volume and weight of infectious waste in a 10 year period and in different conditions, between 39.4 () to 915 () dollars must be spent. The findings indicate the inefficiency and waste of resources, so in order to efficient resource allocation and to encourage further cost containment in infectious waste management we introduce policy recommendation that be taken in three levels.

Nasal mupirocin is found to eradicate effectively methicillin-resistant Staphylococcus aureus (MRSA) from colonized patients, but there are concerns about resistant strains. The aim of this study was to detect the mupirocin resistance and nasal carriage of methicillin resistant S. aureus among healthcare workers (HCWS) at the university hospitals of Tehran. Totally 270 nasal swabs were collected and S. aureus were identified by confirmatory tests in 2013. Determination of oxacillin and mupirocin resistance was performed by disk diffusion method and the mupirocin MIC assessed using E-test. The ileS-2 (mupA) and mecA genes were detected in DNA extracts by multiplex PCR. The prevalence of S. aureus nasal carriage among HCWs was 14.44%. E-test and disk diffusion methods showed 5 and 4 mupirocin resistant isolates, respectively. Statistically significant difference was observed between sex (P=0.035), hospitals (P=0.0001) and occupation (P=0.009) with nasal carriage of S. aureus. A significant difference was found between sex (P=0.041) and occupation (0.034) with regard to MRSA carriage. All MRSA isolates were susceptible to linezolid, fusidic acid and vancomycin. Since the HCWs play an important role as a reservoir for resistant isolates in the hospital setting, regularly screening should be performed for identification of nasal carriers.

The activity of angiotension converting enzyme (ACE; OMIM: 106180) in different brain regions of patients with schizophrenia changed, suggesting a possible involvement of ACE in psychiatric disorders. Genetic polymorphism of insertion/deletion (I/D; dbSNP rs4646994) in the gene encoding ACE has been well defined. The present case-control study was performed on 363 (268 males, 95 females) in-patients with schizophrenia diagnosis, and 363 (268 males, 95 females) healthy blood donor controls. The genotypes of I/D ACE polymorphism were determined using PCR method. PCR products were separated and sized by electrophoresis on a 2% agarose gel. The insertion allele (I) was detected as a 478 bp band, and the deletion allele (D) was visualized as a 191 bp band. The association between genotypes of the I/D polymorphism and the schizophrenia risk was examined by use of odds ratios (OR) and 95% of confidence intervals (CIs). Among females, the II genotype significantly decreased the risk of schizophrenia compared with the DD genotype (OR=0.18, 95%CI: 0.04-0.72, P=0.015). There was significant linear trend for the number of the I allele and schizophrenia risk among females (Chi2=5.19, P=0.023). There was no significant association between I/D polymorphism and susceptibility to schizophrenia among male subjects. There was significant interaction between gender and the II genotype (P=0.031). The II genotype of the I/D polymorphism has a protective effect for schizophrenia among females.

Fungal rhino sinusitis (FRS) is an important infection of para nasal sinuses, which encompasses two main categories; invasive and noninvasive forms according to histopathological findings. Aspergillus spp are the most common species isolated from noninvasive form, while Mucorales are more frequently isolates from acute infections. Four hundred fifty patients suspected to fungal rhino sinusitis were investigated in a cross-sectional prospective study from June 2009 to Sep 2013. All patients under went endoscopic sinus surgery of the middle meatus. Tissue biopsies were investigated for culture, histopathology and molecular examination. Totally, 87 patients were diagnosed with fungal rhinosinusitis. A. flavus was the most common etiological agent of chronic invasive form (CIFRS), allergic fungal rhino sinusitis (AFRS) and fungus ball (FB), while Rhizopus oryze (26.7%) was the most common cause of infection in acute invasive fungal rhino sinusitis (AIFR). However, a few rare species such as Shyzophyllum commune and Fusarium proliferatum were also isolated. Diabetes is the most important predisposing factor for patients with acute invasive form of sinusitis and the most involved sinuses were unilateral multiple sinuses and maxillary sinus.

β -thalassemia, a monogenic autosomal recessive disorder, is prevalent in Middle East, particularly in Iran. In Iran, near to 20 mutations in the β-globin gene are introduced as common mutations with varying incidence frequencies in each city. Therefore, detection and screening for couples at high risk can help to solve the problems of this disease. In this study, optimized genotyping of two common mutations in Isfahan Province, IVSII-I (G-A) and FSC-8/9 insG, was performed using the T-ARMS method. In this case-control study, 10 healthy individuals and 30 patients affected by β-thalassemia major with a mean 24.76 + 4.5 years were selected from Omid Hospital in Isfahan Province. After designing tetra primers for two prevalent mutations IVSII-I (G-A) and FSC-8/9 insG, samples were genotyped using tetra-primers ARMS PCR technique. We have developed a sensitive single tube tetra-primers PCR assay to detect both IVSII-1 (G-A) and FS8-9 insG mutations. Moreover, we have distinguished homozygous and heterozygous forms of these mutations successfully. The frequency of IVSII-1 (G-A) mutation from 30 patients in Isfahan was 86.6% (33.3% heterozygote, and 53.3% mutant homozygote) and for FS8-9 insG mutation was 16.6% (13.3% heterozygote, and 3.3% mutant homozygote). Tetra-primers ARMS PCR could be a reliable, accurate and simple technique for genotyping SNP and different mutations. So far, no study was done on optimization methods for genotyping mutations in β-thalassemia by T-ARMS. Here, we successfully adjusted and enhanced this method for recognizing two common mutations (FSC-8/9 insG and IVSII-I (G-A)) of β-thalassemia in Isfahan population.

Iran has been active in human nutrition training for the past five decades, but the existing curricular programs do not equip the graduates with the knowledge and skills required for solving food security and nutritional problems of the country. Given this, the Nutrition Department (ND) of Iran's Ministry of Health and Medical Education (MOHME) initiated a curricular reform to develop responsive graduate programs in key areas of nutrition that fill the existing gaps in nutrition training with the goal of improving nutrition policy-making and program development, implementation and evaluation. ND called for a request for proposals for a project entitled "Graduate Level Training in Nutrition". Specifically, with technical assistance from leading academic institutions in Asia, North America and UK, seven new graduate programs were housed in three separate institutions, but coordinated so that together they form a broad multidisciplinary resource for graduate education and research. These seven-degree programs are MSc and PhD in Molecular/Cellular Nutrition, MSc and PhD in Nutritional Epidemiology, MSc and PhD in Food Policy and Nutrition Intervention, and MSc in Community Nutrition. The programs were prepared in collaboration and active participation of selected faculty members of the three Iranian universities, International Union of Nutritional Sciences and the University of Philippines at Los Baños. The development of these programs was made possible through a loan from the World Bank, under the Second Primary Health and Nutrition Project in the MOHME.

HNF4A-p.I463Vvariant, reported previously in two distinct families suspected of MODY-1, is assessed in this report to determine whether it is a mutation or a polymorphism (frequency >1%). 200 Tunisian healthy people were screened for the presence of HNF4A-p.I463V variant, using RFLP-PCR technique and sequencing. Then, the frequency of this variant was estimated in the Tunisian population and compared to other populations registered in genetic databases. We also performed in-silico analysis using PolyPhen2 and Mutation T@sting softwares to assess the probable effect of HNF4A-p.I463V variant. HNF4A-p.I463V had a rare frequency in different populations and was found in 3 control subjects (1.5%) of the studied population. PolyPhen2 predicted that it is a polymorphism, whereas mutation T@sting suggested a probably affected mutant protein. HNF4A-p.I463V has a relatively high frequency (>1%) in our control cohort. It is also present in different ethnicities and in- silico analysis showed conflicting results. For these reasons, HNF4A-p.I463V should not be considered as a mutation responsible for MODY-1.

Crouzon syndrome is a rare genetic disorder inherited in autosomal dominant pattern with complete penetration and variable expressivity.Its most notable characteristic feature is premature synostosis of cranial sutures The case presented is of a 4 yr old boy with box like head with microcephaly, protuberant eyes, hydrocephalus, low visual acquity diagnosed as a case of crouzon syndrome after clinical and radiological assessment.

Tuberous Sclerosis Complex (TSC) is an autosomal-dominant hereditary disorder. This syndrome is characterized by tumor-like malformations in several organs, as well as the heart. This report summarizes a case of TSC in a premature infant, born at 34 weeks’ gestation with ascites. After birth, multiple cardiac mass, subependymal cysts and hypopigmented macules were detected. To our knowledge, this is the first case report of early onset of TSC with chylous ascites in Iran.