Antibacterial resistance patterns of Acinetobacter baumannii complex: The results of Isfahan Antimicrobial Resistance Surveillance-1 Program

Objective: To determine the antibiotic resistance patterns of the Acinetobacter (A.) baumannii complex isolates that cause the confirmed infection. Methods: The present descriptive study was performed from March 2016 to March 2018 in three referral hospitals in Isfahan, Iran. All A. baumannii complex strains isolated from different clinical samples were identified by conventional phenotypic methods and antibiotic susceptibility pattern was detected. After the clinical investigation, contaminated samples were excluded and the source (hospital/community) and site of the infection were determined. Data on antibiotic susceptibility testing were extracted from WHONET software and analysis was done with SPSS. Results: From 254 patients who had confirmed A. baumannii complex infection, 158 (62.20%) cases were male, 27 (10.63%) were less than 20 years old, 172 (67.72%) had healthcare-Associated infections and 96 (37.79%) were admitted in intensive care units. The most frequent infection was bloodstream infections (111, 43.70%). Our results showed that most of the isolates were resistant to most of the antibiotics (more than 75.00%) and a lower rate of non-susceptibility was observed against minocycline (20, 44.44%) and colistin (0%). The rate of multidrug-resistant isolates was 88.97%. There was no significant difference between resistance of A. baumannii complex isolates according to age. However, the resistance to amikacin and minocycline and the rate of multidrug resistance (MDR) were significantly different between males and females. In patients with healthcare associated infection (HAI), MDR isolates were significantly different regarding admission in ICU ward. Resistance to levofloxacin and ciprofloxacin were lower in isolates from patients with bloodstream infections in comparison to other diagnoses. Conclusions: In our study, a high level of antibiotic resistance was detected in both community-Acquired and healthcare-Associated A. baumannii complex infections. Appropriate antibiotic prescription in a clinical setting is an essential need for the control and prevention of A. baumannii resistant infections.

Changes in Liver Enzymes and Metabolic Profile in Adolescents with Fatty Liver following Exercise Interventions / 대한소아소화기영양학회지

Purpose@#Nonalcoholic fatty liver disease (NAFLD) is the most frequent cause of chronic liver diseases in both adults and children with obesity. The aim of this study was to compare the changes in liver enzymes and metabolic profile in adolescents with fatty liver following selected school-based exercise (SBE) and high-intensity interval training (HIIT) interventions. @*Methods@#In a semi-experimental study, 34 obese male adolescents with clinically defined NAFLD were divided into the HIIT (n=11, age=12.81±1.02 years, body mass index [BMI]=26.68 ±2.32 kg/㎡ ), selected SBE (n=11, age=13.39±0.95 years, BMI=26.47±1.74 kg/㎡), and control (n=12, age=13.14±1.49 years, BMI=26.45±2.21 kg/㎡ ) groups. The ultrasonography NAFLD grade, peak oxygen uptake (VO 2peak ), lipid profile, insulin resistance, and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels of the participants were measured before and after the exercise interventions. @*Results@#The BMI, waist-to-hip ratio, and body fat percentage of the participants decreased, and a significant increase in VO 2peak was observed after the intervention; however, the HIIT group showed a significant improvement compared with the SBE group (p0.01). @*Conclusion@#HIIT and SBE are equally effective in improving health parameters in obese children and adolescents.

Changes in Liver Enzymes and Metabolic Profile in Adolescents with Fatty Liver following Exercise Interventions / 대한소아소화기영양학회지

Purpose@#Nonalcoholic fatty liver disease (NAFLD) is the most frequent cause of chronic liver diseases in both adults and children with obesity. The aim of this study was to compare the changes in liver enzymes and metabolic profile in adolescents with fatty liver following selected school-based exercise (SBE) and high-intensity interval training (HIIT) interventions. @*Methods@#In a semi-experimental study, 34 obese male adolescents with clinically defined NAFLD were divided into the HIIT (n=11, age=12.81±1.02 years, body mass index [BMI]=26.68 ±2.32 kg/㎡ ), selected SBE (n=11, age=13.39±0.95 years, BMI=26.47±1.74 kg/㎡), and control (n=12, age=13.14±1.49 years, BMI=26.45±2.21 kg/㎡ ) groups. The ultrasonography NAFLD grade, peak oxygen uptake (VO 2peak ), lipid profile, insulin resistance, and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels of the participants were measured before and after the exercise interventions. @*Results@#The BMI, waist-to-hip ratio, and body fat percentage of the participants decreased, and a significant increase in VO 2peak was observed after the intervention; however, the HIIT group showed a significant improvement compared with the SBE group (p0.01). @*Conclusion@#HIIT and SBE are equally effective in improving health parameters in obese children and adolescents.

Periconceptional care and offspring health at birth and long term, from the perspective of Avicenna / 中西医结合学报

Periconceptional care such as lifestyle plays an important impact role in offspring health. The aim of the present study was to clarify the perspective of Avicenna on periconceptional care. Avicenna (980-1037 A.D.) was one of the outstanding Persian physicians, who made great contributions to the field of medical sciences, in particular, obstetrics. In advance, Avicenna's book, Canon of Medicine, was considered to find his perspectives on periconceptional care. Then, his ideas and theories were compared to the current findings by searching the keywords in main indexing systems including PubMed/MEDLINE, Scopus and Institute for Scientific Information Web of Science as well as the search engine of Google Scholar. Current investigations show that gamete quality, pregnancy outcome, and offspring health at birth and long term depend on both parents' lifestyle in pre- and periconceptional period, as well as the intrauterine environment. Avicenna believed that seminal fluid, sperm, ovum, and developing conditions in utero were influenced by the stages of food digestion and the function of some organs. On the other hand, food digestion and function of the organs also depend on each parent's lifestyle and environmental factors. He mentioned 6 principles of healthy lifestyle: exercise, nutrition, sleep and awareness, excretion of body wastes and retention of necessary materials, psychic features, as well as air and climate. Thus, a multicomponent healthy lifestyle should be considered by parents of child-bearing age in an appropriate period before and in early pregnancy as well as elimination of any disorders in parents, to give birth to more healthy offspring.

Body Weight Misperception and Psychological Distress Among Children and Adolescents: The CASPIAN-V Study

OBJECTIVES: Misperception of weight status is a risk factor that affects psychological health. The aim of this study was to evaluate the association between weight misperception patterns and psychological distress among Iranian children and adolescents. METHODS: This was a cross-sectional nationwide study where data was collected from 14,440 students, aged 7–18 years who participated in the national school-based surveillance program (CASPIAN-V). The students’ weight perception and psychological distress were assessed by validated questionnaires. Weight misperception was classified as misperception of being either underweight or overweight with respect to actual weight. RESULTS: The rate of weight misperception in all study participants was 59.1%. In groups with a perception of being underweight or overweight, the risks of worthlessness, being worried, experiencing aggression, insomnia, or depression, were significantly higher than groups with an accurate weight perception (p < 0.05). The risk of anxiety in girls of normal weight who perceived themselves as underweight, decreased by 57% compared to girls with an accurate weight perception (OR: 0.43; 95% CI, 0.28–0.66). CONCLUSION: Weight misperception is highly prevalent among Iranian children and adolescents and is associated with their psychological health status. Appropriate education intervention needs to be developed to improve the children and adolescents’ perception of their body weight status.

Lack of Evidence of the Role of APOA5 3’UTR Polymorphisms in Iranian Children and Adolescents with Metabolic Syndrome

BACKGROUND: Metabolic syndrome (MetS) is a complex and multifactorial disorder characterized by insulin resistance, dyslipidaemia, hyperglycemia, abdominal obesity, and elevated blood pressure. The apolipoprotein A5 (APOA5) gene variants have been reported to correlate with two major components of MetS, including low levels of high density lipoprotein cholesterol (HDL-C) and high levels of triglyceride. In the present study, we explored the associations between five single nucleotide polymorphisms (SNPs) of APOA5 gene and the MetS risk. METHODS: In a case-control design, 120 Iranian children and adolescents with/without MetS were genotyped by polymerase chain reaction-sequencing for these SNPs. Then, we investigated the association of SNPs, individually or in haplotype constructs, with MetS risk. RESULTS: The rs34089864 variant and H1 haplotype (harboring the two major alleles of rs619054 and rs34089864) were associated with HDL-C levels. However, there was no significant association between different haplotypes/individual SNPs and MetS risk. CONCLUSION: These results presented no association of APOA5 3’UTR SNPs with MetS. Further studies, including other polymorphisms, are required to investigate the involvement of APOA5 gene in the genetic susceptibility to MetS in the pediatric age group.

Health impacts of obesity

The aim of this communication is to provide some evidence linking the overweight/obesity and their impacts on different dimensions of health. We reviewed the related studies published from 1990 up till now through PubMed Central/Medline, which provide evidence linking obesity with health related issues. It is a risk factor for metabolic disorders and leads to serious health consequences for individuals and burden for the health care system as a whole. Literature search showed that it is related to at least 18 co-morbidities which are attributable to overweight and obesity. Moreover obese individuals more often suffer from significant joint pains, disorders and it also has social as well as psychological impairments. It is high time that countries facing the problems of obesity initiate some intervention measures to monitor and control this growing epidemic

Association of geographical distribution of air quality index and type 2 diabetes mellitus in Isfahan, Iran

Air pollution is a hazardous environmental problem with several adverse health effects including its impact on the development of chronic diseases as diabetes mellitus. This study aimed to investigate the association of geographical distribution of air quality index [AQI] and type 2 diabetes mellitus in an air-polluted city by using geographic information system [GIS]. This cross-sectional study was conducted in Isfahan, Iran. The records that have been registered from 2009 to 2012 in major referral public diabetes clinics were gathered; they included data of 1467 diabetic patients. Their living area was represented with spots in the city map. AQI data were also interpolated from monitoring stations spreading around the city. The GIS maps of air pollutants and diabetes were developed and the associations were determined. The density of diabetic population was higher in highly polluted areas compared with areas with the lower levels of air pollution. No significant correlation was documented between the distribution of diabetic patients and air pollution level throughout the city. Although the density of diabetic patients was higher in areas with higher air pollution, but the lack of association between AQI and the prevalence of diabetes might be because the air of different parts of the city was highly polluted, and we could not compare the prevalence of diabetes in areas with clean and polluted air

Is the association of continuous metabolic syndrome risk score with body mass index independent of physical activity? The CASPIAN-III study

BACKGROUND/OBJECTIVES: Although the association of body mass index (BMI) with metabolic syndrome (MetS) is well documented, there is little knowledge on the independent and joint associations of BMI and physical activity with MetS risk based on a continuous scoring system. This study was designed to explore the effect of physical activity on interactions between excess body weight and continuous metabolic syndrome (cMetS) in a nationwide survey of Iranian children and adolescents. SUBJECTS/METHODS: Data on 5,625 school students between 10 and 18 years of age were analyzed. BMI percentiles, screen time activity (STA), leisure time physical activity (LTPA) levels, and components of cMetS risk score were extracted. Standardized residuals (z-scores) were calculated for MetS components. Linear regression models were used to study the interactions between different combinations of cMetS, LTPA, and BMI percentiles. RESULTS: Overall, 984 (17.5%) subjects were underweight, whereas 501 (8.9%) and 451 (8%) participants were overweight and obese, respectively. All standardized values for cMetS components, except fasting blood glucose level, were directly correlated with BMI percentiles in all models (P-trend < 0.001); these associations were independent of STA and LTPA levels. Linear associations were also observed among LTPA and standardized residuals for blood pressure, high-density lipoprotein, and waist circumference (P-trend < 0.01). CONCLUSIONS: Our findings suggest that BMI percentiles are associated with cMetS risk score independent of LTPA and STA levels.

Indicators developed to evaluate the international framework convention on tobacco control in Iran; a grounded theory study

This study aimed to develop indicators for evaluating the implementation of The Framework Convention on Tobacco Control [FCTC] in Iran. We used the "grounded theory" framework. Totally, 265 policy-makers, stakeholders, and community members were recruited by purposeful sampling in 2008. After analyzing the gathered data, 251 indicators, including 82 indicators as "applied indicators", were derived from second-level codes for three groups. A suitable evaluation questionnaire can be designed based on the extracted indicators for policy makers, stakeholders, and the community to follow the implementation of the FCTC in Iran

nationwide survey on the daily screen time of Iranian children and adolescents: the Caspian - IV study

Leisure time activity is an important life-style habit. This study aims to determine the screen time of a nationally representative sample of Iranian children and adolescents. This nationwide cross-sectional study was conducted as part of the fourth survey of a surveillance system. The participants consisted of 14880 students, with aged range from 6 to 18 years, living in 30 provinces in Iran. Screen time, i.e. the time spent on watching television [TV]/video and computer games during leisure time, was assessed by using the questionnaire of the Globasl Student Health Survey of the World Health Organization. The study participants were 13486 school students [participation rate of90.6%] with a mean age of12. 47 [3.36] years. Overall, 75.6% of students were from urban and 24.4% from rural areas and 50.8% were boys respectively. Overall, 33.4% and 53% of students watched TV/video more than 2 h a day in their leisure time during school days and holidays, respectively. Likewise, 6.3% and 10.9% of students used computer more than 2 h a day in their leisure time during the school days and holidays, respectively. Overall, 47.1% of urban students and 24.2% of rural students used personal computer in their leisure time during the school days. The corresponding figures were 50.8% and 27.2% in weekends and holidays, respectively. The time spent on screen activities is long in a considerably high number of Iranian children and adolescents. It should be reduced by increasing the public awareness and by providing facilities for regular daily physic activity for students' leisure times

Association of overweight and obesity with mental distress in Iranian adolescents: the CASPIAN-III study

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 of psychological distress. This finding might be due to the positive attitude of family and peers to fatness in adolescence

Child weight growth trajectory and its determinants in a sample of Iranian children from birth until 2 years of age

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

Effects of zinc supplementation on subscales of anorexia in children: a randomized controlled trial

This study aims to assess the effects of zinc supplementation on improving the appetite and its subscales in children. This study was conducted in 2013 in Isfahan, Iran. It had two phases. At the first step, after validation of the Child Eating Behaviour Questionaire [CEBQ], it was completed for 300 preschool children, who were randomly selected. The second phase was conducted as a randomized controlled trial. Eighty of these children were randomly selected, and were randomly assigned to two groups of equal number receiving zinc [10 mg/day] or placebo for 12 weeks. Overall 77 children completed the trial [39 in the case and 3 in the control group]. The results showed that zinc supplement can improve calorie intake in children by affecting some CEBQ subscales like Emotional over Eating and Food Responsible. Zinc supplementation had positive impact in promoting the calorie intake and some subscales of anorexia

Frequency, causes, and places of unintentional injuries in a nationally representative sample of Iranian children and adolescents: the CASPIAN-IV study

This study aims to assess the frequency, causes, and places of injuries in a nationally representative sample of Iranian children and adolescents, as well as the referral, places allocated for injured individuals. This nationwide study was conducted in 2011-2012 among 13486 elementary, secondary and high-school students who were selected by random cluster stratified multistage sampling from 30 provinces in Iran. The Global School-based Health Survey questionnaire of the World Health Organization was used. The study participants consisted of 50.8% boys, 75.6% urban resident with a mean age of 12.5 years. Overall, 20.25% of participants reported that they were minimally injured once in the last 12 months; this prevalence was higher in boys than in girls [25.74% vs. 14.58%, respectively, P < 0.001], without significant difference in urban [20.11%] and rural [20.69%] areas. Most of them [39.92%] were injured at homes or house yards with higher prevalence in girls than in boys [48.61% vs. 35.17%, respectively, P < 0.001] and in rural than in urban areas [27.30% vs. 20.89%, respectively, P < 0.001]. Schools were reported as the second prevalent site of injury occurrence [22.50%]. Emergency departments and physician offices were the most prevalent referral places for injured individuals [32.31% and 22.38%, respectively]. Most of the school injuries occurred during play or sport activities [45.92%]. Prevention of unintentional injuries should be considered as a health priority. Appropriate preventive strategies should be enhanced at homes and schools

Relationship of serum magnesium and vitamin D levels in a nationally-representative sample of Iranian adolescents: the CASPIAN-III study

This study aims to assess the relationship of serum Mg and vitamin D levels in a nationally-representative sample of Iranian adolescents. The study participants consisted of 330 students, aged range from 10 to 18 years, consisting of an equal number of individuals with and without hypovitaminosis D. The correlation between serum 25 hydroxy vitamin D [25[OH] D] and magnesium [Mg] concentrations was determined. The mean age of participants was 14.74 +/- 2.587 years, without significant difference between those with hypovitaminosis D and those without it. The mean 25[OH] D level was 6.34 +/- 1.47 ng/ml in the group with hypovitaminosis D and 39.27 +/- 6.42 ng/ml in the group without it. The mean Mg level was 0.80 +/- 0.23 mg/dl with lower level in the group with hypovitaminosis D than in others [0.73 +/- 0.22 mg/dl vs. 0.87 +/- 0.22mg/dl, respectively] and according to t-test analysis, significant lower levels in the deficient group was observed [P = 0.0001]. The linear regression analysis showed the meaningful relationship between Mg and 25[OH] D serum levels [P = 0.0001]. Our study revealed significant associations between serum Mg and 25[OH] D levels. This finding may be of use for further studies on the prevention and management of hypovitaminosis D in children and adolescents. Further longitudinal studies shall evaluate the underlying mechanisms and the clinical significance of the current findings

nationwide survey on some hygienic behaviors of iranian children and adolescents: the caspian-iv study

This study aims to assess the frequency of some hygienic behaviors that is, tooth brushing and hand-washing, in Iranian school students at national level. This nationwide study was conducted in 2011-2012 among 14,880 elementary, secondary and high school students who were selected by random cluster stratified multistage sampling from 30 provinces in Iran. We used the global school-based health survey questionnaire of the World Health Organization. The population of this survey consisted of 13,486 children and adolescents [participation rate of 90.6%] including 49.2% girls and 75.6% urban inhabitants. The mean age of participants was 12.5 years [12.3-12.6, 95% confidence interval] According to the self-report of students, 26.9% of them [20.2% of boys and 33.9% of girls] brushed their teeth more than once a day, 37.8% of boys and 42.1% of girls brushed their teeth once a day. In general, girls brushed their teeth more than boys. The frequency of those students who never brushed their teeth was twice in rural than in urban students [11.4% vs. 6.2%, respectively]. In total, 3.4% of the students stated that their school had not an appropriate place for washing hands after toilet, with three-fold higher frequency in rural than in urban schools [6.8% vs. 2.3%, respectively]. 85% of students [87% of girls vs. 83% of boys] reported that they had always washed their hands after toilet, 10.1% did it occasionally and 4.1% did not. This nationwide survey revealed that Iranian students have an acceptable level of hygienic behaviors both in urban and rural areas; however, still it is necessary to improve school health facilities and hygienic habits in Iranian students

Absence of association between -1131T>C polymorphism in the apolipoprotein apoa5 gene and pediatric metabolic syndrome

In the present study, we evaluated the association of rs662799 variant of the APOA5gene with Metabolic syndrome [MetS] in a sample of children and adolescents from Isfahan. This case control study comprised 50 cases of MetS and 50 controls. Mismatched polymerase chain reaction-restriction fragment length polymorphism [mPCR-RFLP] was used to genotype -1131T>C polymorphism. No significant association was documented for APOA 5 genotypes with the measured laboratory parameters for CC, CT, and TT genotypes in the two groups studied. By logistic regression using a dominant model, the odds ratio [95% confidence interval 10 for the MetS was 0.38 [0.139-1.0350 and 0.29 [0.08-1.071 for the unadjusted and adjusted models, respectively. This study suggests that among studied children and adolescents, -1131T>C polymorphism in the APOA5gene may not be a major contributor to the MetS risk

First report on the lipid profile late after Kawasaki disease in Iranian children

Background: Concerns have been raised about the possibility of a predisposition of Kawasaki disease [KD] to abnormal lipid profile after an acute phase of disease, which can predispose them to premature atherosclerosis later in life. We determined the lipid profile of children late after KD, and compared it with controls

Methods: This historical cohort was conducted on 32 subjects: 16 children with history of uncomplicated KD [age 11.8 +/- 3.3 years, interval from the initial episode 7.1 years], and 16 healthy age-matched of their sibling or cousins. Fasting serum total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], and triglycerides [TG] levels were compared between groups. In addition, blood pressure and body mass index [BMI] were measured and compared

Results: Six out of 16 KD patients and 7 out of 16 controls had abnormal lipid values. No significant difference was found in mean values of systolic blood pressures, diastolic blood pressures, BMI, TG, TC, HDL-C, and LDL-C between cases and controls

Conclusions: We conclude that although Iranian KD children probably had no different lipid profile compared with controls, but due to finding dyslipidemia in more than one-third of KD subjects, we suggest that periodic control of lipid values in these patients is of crucial importance