[Kala-azar in Maraveh Tapeh county, Golestan Provice, Iran: seven case reports]

Visceral leishmaniasis, also known as Kala-azar, is one of the main parasitic vector borne diseases, which transmitted by sand fly. The current study reported the seven positive cases of Kala-azar in Maravetapeh county in Golestan province, Iran from 2007-15. Using geographic information system, villages which had confirmed cases of Kala-azar were identified and their geographical information was registered. Villages with confirmed cases of Kala-azar were introduced as at risk villages for visceral leishmaniasis. All of these cases were aged under 6 years and in all of them fever and splenomegaly was reported. All subjects had lower normal range of hemoglobin and plateles. These cases were reported from 6 villages in 3 districts of Maraveh Tapeh County. All of these villages are in hot and dry areas of county and they have mountainous and semi-mountainous geographical status with higher altitude compare to other villages. Fifty two villages of county were recognized as at-risk villages for Kala-azar. Kala-azar presented in sporadic condition in Maravetapeh County. Continuous case finding of Kala-azar for early diagnosis and treatment is necessary

[ neuromuscular response of patients with acute ankle instability in balance recovery]

Acute lateral ankle sprains are the most common injuries referred to emergency departments. The purpose of this study was an overview of the balance recovery mechanism to provide a perspicuous understanding of effects of this trauma on the joint for clinicians to prevent further imposition among chronic ankle instability. The treadmill protocol was used as a dynamic balance test with simulating fall upon 4 posture stabilizer muscles; medialis gastrocnemius / tibialis anterior / vastus medialis [VM] and erector spinae in L3 during sudden acceleration in base of support/ in two sides of the body [involved/ uninvolved as left and right] in sudden acceleration in forward and backward directions upon 20 adult women in two groups [10 LAS subjects with the mean of age; 23.9 +/- 2.03 yrs and 10 normal subjects with the mean of age; 26.4 +/- 3.2 yrs]. The data of [electromyography] were assessed by using one- way repeated measures 2x2x4 ANOVA and multivariate test [P< 0.05]. The results showed a significant interaction in muscle by direction. Significantly higher TA activity was shown in LAS group compared to normal group in forward direction. Significantly higher MG activity in right side of body was demonstrated in normal group than LAS group in backward direction. These findings suggest that by comparison of two sides of the body in two directions for 4 muscles electromyography activation/ significantly symmetric in LAS group than normal group was observed. Acute ankle instability with alternation in neuromusculoskeletal system may affect the dynamic balance control in patient with lateral ankle sprains

Association between ABO blood groups and cardiovascular risk factors in general population of Golestan province, Iran

Cardiovascular disease [CVD] is a common cause of morbidity and mortality. The relationship between ABO blood groups and main risk factors of CVD is unknown. So this study was designed to investigate whether there is an association between ABO blood groups and cardiovascular risk factors in healthy population. In this cross-sectional study, risk factors screening for CVD on 2920 healthy individuals of Golestan province in 2005 were estimated by a questionnaire that aimed to extract information about age, sex, physical activity, smoking, blood group type, weight, height, blood pressure and family history of CVD. Data were analyzed with SPSS 13 and by using Chi Square and ANOVA tests. Out of the total number of 2920, 57.4% were male, 70% inactive, 14% smoker, 25% hypertensive, 23% obese, and 21% had family history of CVD with the mean age of 41.52 +/- 12.317. Blood groups O [32.9%], A [30.1%], B [23.3%] and AB [13.7%] were the most frequent ones, respectively. Amongst cardiac risk factors, it was only the frequency of family history of CVD that varies across different blood groups, and individuals with A blood group reported to have a more frequent family history of CVD as compared with other blood groups. These findings illustrate amongst cardiovascular risk factors only family history of CVD as having a significant correlation with ABO

Population attributable fraction of bronchial anthracosis due to smoke exposure while baking home-made bread in ground oven

Some case-report studies in Iran showed probable association between anthracosis and smoke exposure due to baking homemade bread, population. Therefore we estimated the population attributable fraction [PAF] for this probable association in Iranian population. A hospital-based case-control study, including 83 anthracotic subjects [cases] with 72 controls from surgical ward which were matched by age, conducted in Imam Khomeini hospital in Tehran [From September 2009 to December 2010]. Patients in both case and control groups were interviewed according to [American Thoracic Society] guideline. Exposure to smoke was considered both as a binary and continuous variable [number of years being exposed to smoke] and the population attributable fraction [PAF] were estimated due to smoke exposure. Univariate analysis showed that exposure to smoke as binary variables, age and occupation exposure to dust and education were associated with anthracosis. After Adjusting, only smoke exposure [OR: 3.35, 95% Cl: 1.49-7.55] remain significant. Univariate logistic regression model showed exposure to smoke as continuous variable has significant association with anthracosis. In multiple logistic model only duration [years] of smoke exposure remained significant [OR: 1.05, 95%CI: 1.01-1.09]. PAF due to smoke exposure estimated approximately 48% in our population. Based on the findings of this study, it could be concluded that approximately half of the anthracotic cases are attributed to smoke exposure

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 [PM[10]] 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 PM[10] [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]

[Association between life style and hypertension in rural population of Gorgan]

Introduction: Lifestyle refers to peoples' behavior and pattern that has affected their health. This aim of this study was to determine the association between lifestyle and hypertension in rural population in Gorgan

Material and methods: In this case-control study, 200 hypertensive subjects and 200 controls in Gorgan rural population were selected via two stage sampling method. Data was collected using a questionnaire consists of demographic questions [20 questions] and health promotion lifestyle profile questions [52 questions]. Lifestyle profile questions, contains total life style score and six dimensional physical activities of stress management, interpersonal communication skill, health responsibility, nutrition and spiritual growth. The content validity and reliability [Cronbach's alpha: 87%] of questionnaire was approved. Data were analyzed using Chi Square, T tests and Logistic regression in SPSS version 16. A P-value less than 0.05 were considered as statistically significant

Findings: The mean onset of hypertension was 53.2. Twelve percent of cases and 20.5% of controls were smokers. Also, 57% of cases and 51% of controls had family history of hypertension, 63% of cases and 61.1% controls had BMI of 25 that is higher than normal. In addition, Logistic regression test showed that the association between hypertension and total lifestyle score, physical activity, spiritual growth, interpersonal communication skill, stress management was statistically significant [P-value <0.05]. The results of T-Test showed that the association between health responsibility, physical activity, nutrition, spiritual growth, interpersonal communication skill, stress management in case and control group was statistically significant [P-value <0.05]

Conclusion: The results showed that unhealthy behaviors particularly in nutrition, stress and physical activity has a relationship with hypertension; therefore it is necessary to implement educational programs for people in order to have a healthy life style and healthy behaviors

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 IQ-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

[Effect of progressive muscle relaxation program on self-efficacy and quality of life in caregivers of patients with multiple sclerosis]

MS is a disease of the central nervous system affecting all economic, financial, social, and emotional aspects of individual, family, and community. Performing continuous care leads to chronic stress in caregivers of patients and this in turn threatens their self-efficacy and quality of life. The aim of the present study was to determine the effect of progressive muscle relaxation on self-efficacy and quality of life in caregivers of patients with multiple sclerosis. This was a controlled clinical trial in which 70 family caregivers of MS patients were investigated. The study population was divided into two age- and sex-matched case and control groups. Progressive muscle relaxation techniques were employed for the case group for three months [90 sessions] and its application was followed using a self-report checklist. After three months, self-efficacy and quality of life questionnaires were re-filled by members of both groups. Data were analyzed using descriptive and presumption statistical tests while a p /= 0.05]. Several interventions such as progressive muscle relaxation program with low cost, good safety and effect can help reduce the stress of family caregivers of patients in particular those with chronic diseases such as multiple sclerosis and thus leading to an increase in their self-efficacy, care quality, and quality of life

[Prevalency of metabolic syndrome among adolescents aged 15 to 17 years in Gorgan, northern Iran [2009]]

The metabolic syndrome is a cluster of metabolic disorders that are associated with elevated risk of cardiovascular diseases and type-II diabetes. This study investigated the prevalence of metabolic syndrome among adolescents population in Gorgan, Northern Iran - 2009. A cross-sectional survey was conducted involving 450 adolescents 15- 17 years, selected through 2 stage cluster randomized sampling from high schools. Anthropometric measurements, blood pressure, fasting blood glucose and lipid profile were assessed. Metabolic syndrome was defined according to NHANES III criteria. Data was analyzed by SPSS-16 software, Chi-Square and logestic regration. The overall metabolic syndrome prevalence was 3.3% [CI 95%:1.8-5.4]. More than half of cases [54.6%] had at least 1 or 2 components. High triglyceride level was the most common disorder in both genders [boys 27.6%, girls 52.4%] and then low HDL cholesterol level [17.3%] and central obesity [7.6%] were common among boys and girls respectively. Where as abdominal obesity in boys [0.9%] and hypertension in girls [3.1%] were less common. This study showed that the rate of metabolic syndrome is slightly lower but the obesity in adolescents is higher than other parts of country

[Estatus of knowledge thesis resulted from medical students dissertation fulfilled at Gorgan medical school]

Over half of medical researches in Iran are done by students of different levels as their thesis. In medical school, thesis is a 6 hours mandatory course. This study carried out to determine the publication of thesis in faculty of medical in Gorgan, located in North of Iran. This descriptive study was performed on all thesis and all faculty members who have been advisor of at least one thesis up to the time of this study. To collect data, we used a questionnaire which contained questions about the research, their output and any obstacles to publication. All data have been analyzed by SPSS-13 software and Chi-Square test. According to the collected information, 322 thesis were directed by 43 faculty academic members of Gorgan Medical School. 87.6% and 12.4% thesis supervisors were clinical and basic science academic members respectively. The majority of 127 [39.4%] published papers have either been published by domestic medical journals or represented in medical seminars inside the country. Basic members have published 70% of their papers while only 35.1% of clinical faculty members have published their research findings. Experimental papers have been published more than other papers [48.5%]. The most important publication barrier was lack of time and collaborator in this matter. This study showed that publication rate of medical student thesis is far from ideal

[Mucocutaneons manifestation in end stage renal disease patients under hemodialysis in 5th Azar hospital in Gorgan, Iran [2009]]

Mucocutaneons manifestations are common in hemodialysis patients.The aim of this study was evaluate the prcvalence of cutaneous and mucosal manifestations in end stage renal disease [ESRD] patients who are on the maintenance hemodialysis. This cross sectional study was performed on 100 [51 males, 49 females] hemodialysis patients in 5 Azar hospital in Gorgan, North of Iran during 2009. Patients selected on randomly based an all of them completely examined by a deramatologist for any changes in skin, hair, nail and mucous membrane. If necessary biopsy perform and refer to a pathologist. Data analysed with SPSS-13, mann-whitney, t-test, Chi-Square and Fisher tests. The average age was 49 +/- 12.3 years. The most common causes of ESRD was dibetes mellitus. The most common skin lesion was xerosis [78.3%], after that pruritis [39.1%] lentigo [34.8%] skin discoloration [32.6%] leukonychia [32%] thining of nail bed [24%] were common lesions. Lentigo was more common in female than male 42.85% vs 21.50% [p=0.042]. Xerosis [p<0.01], scaling [p=0.042], lentigo [p<0.01], folliculitis [p<0.01], idio pathic guttate hypopigmentation [p<0.01] leukonychia [p<0.01] and half and half nail [p<0.01] have meaningful correlation with age. There was also meaningful correlation between dialyis duration and skin discoloration [p<0.031] and leukonychia [p<0.041]. Clubhing and ca-p product also have meaningful correlation [p<0.027]. Pruritis [p<0.048] and skin fungal infection [p<0.047] [tinea versi color] also have meaningful correlation with serum ferritin level. Mucocutaneous manifestation were common in end stage renal disease patients

[Prediction of infant motor performance through performance evaluation of behavior]

Nowadays, comprehensive developmental assessment of infants is highly considered. But, some assessments, especially those which use more manipulations on high risk infants, can cause more stress on them. So sometimes it is necessary to use one group of developmental assessments to predict another developmental aspect. The aim of this study was to investigate the relationship between scores of behavioral scale and motor performance. In this cross-sectional study that was conducted in neonatal intensive care unit and pediatric clinic of Shahid Akbarabadi hospital, Tehran, 50 under 2 months low birth weight infants after met inclusion criteria were selected via convinence sampling method. The Test of Infant Motor Performance [TIMP] and the Neonatal Behavioral Assessment Scale [NBAS] was used for assessing motor performance and behavioral performance respectively. The TIMP consist of elicited and observational parts. NBAS was consisted of habituation, social interaction, motor system, state organization, state regulation, autonomic system, smile, supplementary items, and reflex items. There was not any significant relationship between habituation part of NBAS and TIMP and also between autonomus system part of NBAS and observational part of TIMP [P<0.05]. Association between other variables was statistically significant [P>0.05]. Some items of behavioral assessment can be used to predict the motor performance in low birth weight infants

[ effect of family centered empowerment model on the quality of life in elderly people]

The proportion of older adults in the population continues to grow in the developing countries. In addition, in elderly persons decrease quality of life in geriatric because of several factors, such as, low physical activity and impairment in mobility. This study was performed to assess the effect of family centered empowerment model on the quality of life in charmahalobakhtiari elderly people This quasi-experimental study was conducted older adults in 2007-2008. In this study 60 elderly persons were randomly [Stratified Sampling] divided into two groups; experimental [30] and control [30]. Family centered empowerment model was administrated to the individual of experimental group for 3months; subsequently using SF-36 questionnaire, the level of quality of life was measured in the two groups at the beginning and the end of the study. The data was analyzed by using chi-square and nonparametric tests. quality of life score mean in contro group was 41.71. pair test analysis showed that by Using family centered empowerment model, mean of level of quality of life[75.46] in different were increase statically significant [p<0.01], whereas in the control group, these parameters, were unchanged. Our study results showed that using a family centered empowerment model can increase the level of quality of life in older adult in different dimension

[Evaluating the anti-leech effects of tobacco methanolic extract compared with succinyle choline and some other anti-parasite drugs]

Leeches are subcategory of hirudinea family with 650 species. Studies have shown that 50 species of them feed from mammalian blood. Leech infestation can lead to some side effects including: anemia, bleeding, subsequent biting infections, ache, itching, inflammation, high sensitivity and anaphylactic reactions. As no effective drug, without any side effect, has been offered for leeches, we decided to study the anti- leech effects of some herbal and chemical compounds. In this study, 100 Limnatis nilotica leeches were selected from spring waters from south region in Ilam province and the anti-leech effects of tobacco methanolic extract and also some other drugs such as mebendazole, succinyle-choline, metronidazole, triclabendazole, levamisol, niclosamide were investigated and compared with distilled water. First, leeches were put individually in a glass container with 600ml spring water. Then extract and drugs were added and their effects were screened for 720 min and time to paralyze kill and death of each leech was recorded. The results of this study showed that tobacco methanolic extract [600mg/ml] could kill the leaches in the average time of 17 minutes. Average death times for other drugs [triclabendazole, levamisole, niclosomide and metronidazole] were found 118.66, 7, 18.66 and 541.11 min, respectively. The low average paralysing and killing time of tabacco methanol extract, levamisol, niclosomide, triclabendazole reflect anti leech properties of these compounds and therefore they may be used in the treatment of infestation with limnatis nilotica in the future

ABO blood groups distribution and cardiovascular major risk factors in healthy population

This study was designed to investigate whether there was an association between ABO blood groups and cardiovascular risk factors in healthy population. In this cross-sectional study, risk factors screening for cardiovascular disease [CVD] on 5000 healthy persons of Golestan Province, northern Iran, in 2005 was estimated by a questionnaire that included age, sex, physical activity, smoking status, blood group type [if they had blood laboratory tests], weight, height, blood pressure and family history of coronary artery disease [CAD]. Data were analyzed with SPSS version 11.5 and by using Chi Square and ANOVA tests. A p-value less than 0.05 were considered as statistically significant. Amongst 5000 subjects, 2920 had blood laboratory tests and their types of blood group were known. Of the total of 2920, 57.4% were male, 70% were inactive, 14% were smoker, 25% were hypertensive, 23% obese, 21% had family history of CAD and mean age was 41.52 +/- 12.317. Blood group O[32.9%], A[30.1%], B[23.3%] and AB [13.7%], respectively had most frequency. Amongst cardiac risk factors, only frequency of family history of CAD in individual with different blood groups was different [P<0.01] and individual with A blood group reported more family history of CVD versus other blood groups. Amongst cardiovascular risk factors, only family history of CAD had significant relation with ABO

[Methodological assessment of case-crossover studies]

The case-crossover design was developed in the early 1990s to study the effects of transient, short-term exposures on the risk of acute events such as myocardial infarction. To estimate relative risk, the exposure frequency during a period just before outcome onset [hazard period] is compared with exposure frequency during control time[s] in that person rather than in a control. One or more "control times" are supplied by each of the cases themselves to control for confounding by constant characteristics and self-confounding between the trigger's acute and chronic effects. In the analysis of case-crossover studies, exposure frequency in the hazard period is compared with the control period or the individual's usual frequency of exposure. The design has been used frequently for heart diseases, injuries and air pollution epidemiology. This review article looks at published case-crossover studies and is intended to help the reader gain a better understanding of the strengths and limitations of the case-crossover design in studying the epidemiology of injuries and air pollution