Effect of air pollution on onset of acute coronary syndrome in susceptible subgroups

While long-term exposure to air pollutants is associated with an increase in heart diseases and mortality, little information is available about the short-term effects of air pollution. This case-crossover study assessed the relationship of particulate matter (PM10) and carbon monoxide (CO) levels with hospital admission for acute coronary syndrome in Tehran, Islamic Republic of Iran. We interviewed 250 patients with a first episode of acute coronary syndrome and obtained data from hospital records and Tehran Air Quality Control Company. The risk of acute coronary syndrome was significantly associated with elevated concentrations of CO the day before the event (OR 1.18; 95% CI: 1.03-1.34) but not significantly with PM10 (OR 1.00; 95% CI: 0.99-1.02). Stratification by age, sex, diabetes, hypertension and smoking status did not affect the results, but women were more susceptible than men to CO levels (OR for women/men 1.68; 95% CI: 1.25-2.26)

Ethnical variations in the incidence of congenital heart defects in Gorgan, Northern Iran: A single-center study

Background: Congenital heart disease (CHD) is the most common congenital anomaly in newborns. This study was performed to determine the live birth incidence of CHD by ethnicity and sex in Gorgan, Northern Iran. Methods: In this longitudinal, hospital-based study, 18162 live births in Dezyani Hospital in Gorgan, North of Iran, were screened for CHD, from 2007 through 2009. Clinical examination, echocardiography, color Doppler, and cardio catheterization were used as diagnostic tools. Sex, ethnicity, and type of CHD for each case were recorded in a pre-designed questionnaire. Results: The incidence rates of CHD in the native Fars, Sistani, and Turkmen subjects were 5.73 (95%CI: 4.53-7.15), 12.27 (95%CI: 8.74-16.73), and 15.93 (95%CI: 10.00-24.02) per 1000 live births, respectively. The Turkmen to native Fars and Sistani to native Fars relative risk for congenital CHD malformations was 2.77 (95%CI: 1.73-4.44; p value < 0.001) and 1.29 (95%CI: 0.77-2.18; p value < 0.323), respectively. While atrial septal defect was the most common lesion in the native Fars subjects (2.14 per 1000 [95%CI: 1.42-3.06]) and in the Sistani subjects (2.84 per 1000 [95%CI: 1.29-5.36]), in the Turkmen subjects, ventricular septal defect (4.36 per 1000 [95%CI: 1.59-9.43]), followed by atrial septal defect, was the most frequent lesion. Conclusion: This study showed that the incidence and pattern of CHD among live births in Gorgan, North of Iran, varied according to ethnicity. The risk of CHD was higher in the Turkmen and Sistani groups than in the Fars population

Association between pruritus and serum concentrations of parathormone, calcium and phosphorus in hemodialysis patients.

Chronic renal disorders have a progressive course in most cases, and finally result in end-stage renal disease (ESRD). Hemodialysis (HD) is one of the mainstays in the treatment of these patients. Disturbance in calcium (Ca) and phosphorus (P) metabolism and alteration of serum levels of parathormone (PTH) are observed in these patients. One of the most common cutaneous manifestations in patients on HD is pruritus. The aim of this study is to evaluate the association between pruritus and serum concentrations of Ca, P and PTH in patients with chronic renal disease. This analytic, descriptive, cross-sectional study was performed on 120 patients on HD at the Fifth-Azar Hospital in Gorgan, Iran, in 2010. Information related to the patients, including age, gender, pruritus, time of pruritus and duration on dialysis, was extracted from questionnaires. Serum concentrations of intact PTH, Ca and P were measured. Data were analyzed by the chi-square test and SPSS-16 software. A P-value less than 0.05 was considered statistically significant. Among the 120 study patients, 50% were male and the mean age (±SD) was 49 ± 12.3 years. Sixty percent of the patients had pruritus, of whom 33.3% had PTH levels above the normal range. Among the 40% of the patients who did not have pruritus, 39.6% had PTH levels higher than the normal levels. The mean serum Ca and P levels were 8.44 ± 1.65 mg/dL and 5.48 ± 1.81 mg/dL, respectively. The mean (±SD) Ca-P product was 55.46 ± 47.16 and the mean PTH concentration was 274.34 ± 286.53 pg/mL. No significant association was found between pruritus and age, sex, serum PTH and P levels as well as Ca-P product. However, the association between serum Ca levels and pruritus was significant (P = 0.03). Our study showed that most patients with pruritus had serum Ca levels in the abnormal range (lower or higher), and there was no significant correlation between serum iPTH level and pruritis. Thus, good control of serum Ca levels is important to reduce pruritus in these patients

Maternal risk factors for oral clefts: A case-control study

Introduction: A cleft lip with or without a cleft palate is one of the major congenital anomalies observed in newborns. This study explored the risk factors for oral clefts in Gorgan, Northern Iran. Materials and Methods: This hospital-based case-control study was performed in three hospitals in Gorgan, Northern Iran between April 2006 and December 2009. The case group contained 33 newborns with oral clefts and the control group contained 63 healthy newborns. Clinical and demographic factors, including date of birth, gender of the newborns, type of oral cleft, consanguinity of the parents, parental ethnicity, and the mother's parity, age, education and intake of folic acid were recorded for analysis. Results: A significant association was found between parity higher than 2 and the risk of an oral cleft (OR= 3.33, CI 95% [1.20, 9.19], P> 0.02). According to ethnicity, the odds ratio for oral clefts was 0.87 in Turkmens compared with Sistani people (CI 95% [0.25, 2.96]) and 1.11 in native Fars people compared with Sistani people (CI 95% [0.38, 3.20]). A lack of folic acid consumption was associated with an increased risk of oral clefts but this was not statistically significant (OR = 1.42, CI 95% [0.58, 3.49]). There were no significant associations between sex (OR boy/girl = 0.96, CI 95% [0.41, 2.23]), parent familial relations (OR = 1.07, CI 95% [0.43, 2.63]), mother's age and oral clefts. Conclusions: The results of this study indicate that higher parity is significantly associated with an increased risk of an oral cleft, while Fars ethnicity and a low intake of folic acid increased the incidence of oral clefts but not significantly

Bone mineral density in Iranian patients: Effects of age, sex, and body mass index

Introduction: Osteoporosis is a multifactorial skeletal disease that is characterized by reduced bone mineral density (BMD). BMD values de-pend on several factors such as age, sex and age at menopause. The purpose of this study was to determine the prevalence and changes in bone mineral density in Iranian patients. Meth-ods: Three hundred patients were selected through random sampling technique in 2009. BMD was assessed by Norland (Excell) technique at the lumbar and femoral neck. Weight and height were measured through standard methods. A thorough history was taken from each patient. The data was analyzed using SPSS software version 13.0. P-values less than 0.05 were con-sidered statistically significant. Results: From among the 300 studied patients, 86.6% were fe-male. their mean age was 52.7 years. Their av-erage body mass index (BMI) was 28.14 kg/m2. Mean T-Score at lumbar spine and femoral neck was −1.07 ± 1.19 and −1.75 ± 1.33 respectively. Mean BMD value at lumbar spine and femoral neck was 0.92 ± 0.19 and 0.77 ± 0.16 respectively. The prevalence of osteoporosis at lumbar spine and femoral neck was 33.7% and 16.7, respec-tively. There was a significant correlation be-tween age, BMI and BMD values (P-Value < 0.01). Correlation between gender and BMD value at the lumbar spine and femoral neck was not sig-nificant. Conclusion: This study shows that age- ing and low BMI are risk factors associated with bone loss. it is recommended to measure BMD and implement prevention programs for high- risk people. Keywords: Bone Mineral Density; Body Mass Index;Age; Gende

Prevalence of stress among Iranian medical students: A questionnaire survey

A cross-sectional study measured the frequency of self-reported stress symptoms among a weighted random sample of medical students in Isfahan, Islamic Republic of Iran. The data were gathered using the Kessler 10-item psychological distress scale. The overall prevalence of stress among 222 students was 61.3% and there were no statistically significant differences in stress levels between students in the pre-clinical and clinical phases or different years of study. Married students had significantly lower scores than single students but there were no differences between the sexes. Students who chose to study medicine had lower stress scores than those who were influenced by family or had no choice about the subject. Students with mild to moderate stress were significantly more likely to suffer physical problems (OR = 4.42). Interventions are needed to tackle stress and improve Iranian medical students' physical and psychological well-being

Association of serum fetuin-A and biochemical parameters in hemodialysis patients.

Fetuin-A, a hepatic glycoprotein present in the circulation, is a potential inhibitor for systemic calcification. The main aim of this study was to evaluate the association between fetuin-A and other biochemical parameters as facilitator factors for developing atherosclerosis in hemodialysis (HD) patients. This case-control study was conducted on 44 HD patients undergoing treatment in 2012. Parathormone (i-PTH) and fetuin levels were performed by the enzyme-linked immunosorbent assay method, high-sensitivity C-reactive protein (hs-CRP) by chemiluminescence, low-density lipoprotein by direct enzymatic, calcium and albumin by colorimetric and phosphorous by ultraviolet (UV) methods. Chi-square was used for evaluating the association between variables and t-test was used for comparing the mean of the quantitative variables for the two groups. SPSS-16 software was used for data analysis and P-value less than 5% was considered as significant. Mean of serum fetuin level was 23.25 ± 4.90 ng/mL in HD patients and 32.92 ± 5.21 in the control group. Median of hs-CRP was 2.45 mg/dL in the patients and 1.00 mg/dL in the control group and i-PTH was 74.3 pg/mL in the patients and 7.30 pg/mL in the control group. The calcium-phosphorous product was 46.77 ± 14.22 mg/dL in the patient and 31.73 ± 6.48 mg/dL in the control group. A reverse significant association was found between fetuin-A and hs-CRP in this study. In this study, serum fetuin-A level in HD patients was lower than controls. Therefore, a low level of fetuin-A seems to be associated with atherosclerosis, inflammation and malnutrition

Clinical microbiology study of diabetic foot ulcer in Iran; pathogens and antibacterial susceptibility

The aim of this study was to investigate microbial pathogens and their antibiotic susceptibility profile in infected diabetic foot ulcers in Iranian patients. This was a one-year cross sectional study on diabetic patients with infected diabetic foot ulcer at Shariati Teaching Hospital, Tehran, Iran. Grade of ulcer was determined by Wagner's criteria. Specimens were obtained from the base of ulcer, deep part of the wound or aspiration and were tested with gram staining and antibacterial susceptibility was determined with both disk diffusion and E-Test methods. Total of 546 pathogens were isolated from 165 ulcers of 149 patients. Gram positive aerobes including Enterococcal species and methicillin resistant Staphylococcus aureus (S. aureus) (21.4 and 19.4%, respectively) were identified as the most common pathogens followed by Gram negative isolates including Escherichia coli and Pseudomonas-aeruginosa (12.6 and 5.4%, respectively). The majority of wounds were classified as Wagner grades 2 and 3 (15.7 and 75.7%). Appropriate empiric treatment to cover both these Gram positive and Gram negative pathogens is crucially important

Determinants of childhood obesity in representative sample of children in north east of iran

Childhood obesity has become, a global public health problem, and epidemiological studies are important to identify its determinants in different populations. This study aimed to investigate factors associated with obesity in a representative sample of children in Neishabour, Iran. This study was conducted among 1500 randomly selected 6-12-year-old students from urban areas of Neishabour, northeast of Iran. Then, through a case-control study, 114 obese (BMI � 95 th percentile of Iranian reference) children were selected as the case group and were compared with 102 controls (15 th � BMI 85 th percentile). Factors suggested to be associated with weight status were investigated, for example, parental obesity, child physical activity levels, socio-economic status (SES), and so forth. The analysis was conducted using univariate and multivariate logistic regression (MLR) in SPSS version 16. In univariate logistic regression model, birth weight, birth order, family extension, TV watching, sleep duration, physical activity, parents job, parents education, parental obesity history, and SES were significantly associated with childrens obesity. After MLR analysis, physical activity and parental obesity history remained statistically significant in the model. Our findings showed that physical activity and parental obesity history are the most important determinants for childhood obesity in our population. This finding should be considered in implementation of preventive interventions. Copyright © 2012 Fereshteh Baygi et al

Mucocutaneous manifestations and nail changes in patients with end-stage renal disease on hemodialysis.

Mucocutaneous manifestations are common among patients on hemodialysis (HD). This study was undertaken to determine the prevalence of mucocutaneous manifestations in patients with end-stage renal disease (ESRD) who are on HD. In this cross-sectional, descriptive and analytic study conducted in 2009, 100 patients on HD at the Five Azar Hospital in Gorgan city were randomly selected. All the patients underwent detailed examination by a dermatologist to look for lesions in the skin, hair, nail and mucous membranes; if felt necessary, biopsy was obtained from the lesions. The findings were statistically analyzed using SPSS-13 software. For evaluation of normality of distribution, Kolmogorov-Smirnov was used, for quantitative variables Mann-Whitney and T-test (abnormal distribution) were used and for qualitative variables, Chi-2 and Fisher were used. In this study, P-value less than 0.05 was considered significant. Fifty-one males and 49 females were enrolled. The mean age was 49 ± 12 years. Diabetes was the most common cause of ESRD. In 95% of the patients, at least one mucocutaneous manifestation was present. Xerosis (78.3%) was the most common lesion, followed by pruritus (39.1%), lentigo (34.8%), skin discoloration (32.6%), leukonychia (32%) and thinning of the nail bed (24%). Xerosis, scaling, lentigo, folliculitis, idiopathic guttate hypopigmentation, leukonychia and half and half nail were associated with age. A significant relationship was seen between duration on dialysis and skin discoloration and leukonychia. Clubbing had a significant association with calcium-phosphorus product (Ca � P). There was a significant association between serum ferritin level and pruritus and tinea versicolor lesions. Our study shows that mucocutaneous manifestations are common among patients with ESRD. Identification of these manifestations and their association with causative factors are useful for preventing the lesions