Regression dilution bias in blood pressure and body mass index in a longitudinal population-based cohort study

Use of single measurement of risk factors can distort their estimated effects, due to random error in measurements. The aim of this study was to examine the extent of underestimation in the estimated effect of common variables in physical exam i.e. systolic and diastolic blood pressure [SBP, DBP] and body mass index [BMI] on cardiovascular diseases in Tehran Lipid and Glucose Study [TLGS]. A subsample [1167 men and 1786 women] of the original cohort, who had replicate measures of the variables in triennial interval, was used to calculate the regression dilution ratios [RDRs] in men and women. RDRs were determined by parametric and nonparametric methods. Hazard ratios [HR] of risk factors, per one standard deviation change, were corrected for regression dilution bias. The estimated RDRs by parametric method in men and women were 45% and 35% for SBP and 54% and 64% for DBP, respectively. There were 26% and 25% underestimation in HR of SBP and 23% and 33% in HR of DBP in men and women. The corresponding underestimation for BMI was about 8%. RDRs of men and women and in age groups by both methods were fairly similar. They were relatively constant during the 10-year follow-up for SBP and BMI. Using baseline measurements of blood pressure underestimate its real association with CVD events and the estimated HRs. The underestimations are independent of age and sex, and it can be fairly constant in short to moderate time intervals

Tuberculosis-related awareness among people living in rural areas of Gorgan District: a cross sectional study

Tuberculosis is an infectious disease that caused by Mycobacterium Tuberculosis [TB]. Despite the implementation of free treatment, detection rate of TB remains low. Lake of awareness is a main reason for not expressing symptoms in patients. The study aimed to determine the level ofawareness about TB among rural areas of Gorgan. This study was cross-sectional research which was conducted in 2014-2015 in Gorgan villagers [age>/= 15 non-TB]. These individuals were selected by two-staged cluster sampling. The total sample size was 672. The data collection instrument was a researcher-made questionnaire. Face and content validity and also test-retest method were used for validity and reliability, respectively. Participation of individuals in this study was voluntary and with informed consent. The collected data was analyzed using SPSS 16 software. Findings analysis by independent Sample T-Test and Anova test. The mean age of respondents was 33 +/- 1.17. The mean score of villagers' awareness was 30.95+/-6.16. The awareness level of 330 participants [49.1%] was high. There was a significant difference between awareness and some variables such as literacy level and age [p<0.05]. There wasn't a significant difference between awareness and gender, family size, history of morbidity, and ethnicity. According to results of this study, Level of villagers'awareness about TB was high, but they lacked awareness on some aspects like the ways of transmission and virulence of disease. It seems that increasing awareness and surveying of influent factors on awareness in people who have TB symptoms is necessary

Association of metabolic syndrome with body fat percent, anthropometric indices in 10 to 18 year old adolescents

Background: Our aim was to evaluate the association of metabolic syndrome [MetS] and its components with body fat percentage [BFP] and anthropometric indicesin10 to 18year old adolescents

Methods: This was a cross-sectional study conducted on 134 Tehranian adolescents, aged 10 to 18 years [66 boys and 68 girls] in 2007. The MetS definition proposed by Cook et al. was used. Logistic regression was used to determine the relationship of MetS and its components with body mass index [BMI], waist circumference [WC], waist to height ratio [WHtR], and BFP. Using the areas under the receiver operating characteristic [ROC] curve, the discriminatory ability of anthropometric measurements and BFP was evaluated

Results: The mean+/-SD forage of boys and girls was14.5+/-2.3and13.0+/-2.9 years, respectively [P=0.001]; the prevalence of MetS in these groups was 32.3 and6.5%, respectively [P=0.001]. After adjusting for sex and physical activity, the highest odds ratios [95% CI] for MetS and hypertriglyceridemia were found for WC, 6.27 [2.63-14.94; P<0.05] and 3.14 [1.87-5.27; P<0.05], respectively, and those for low HDL-C and hypertension were found for BMI, 2.91 [1.73-4.90; P<0.05] and 2.26 [1.27-4.02; P=0.05], respectively. After adjusting for sex and physical activity, the highest area under ROC curve for MetS and hypertriglyceridemia was seen for WC [P=0.001], for hypertension it was seen for BMI [P=0.001], and for low HDL-C it was observed for both WC and BMI [P=0.001]

Conclusions: In adolescents, WC was the best predictor of MetS and hypertriglyceridemia, BMI was the best predictor of hypertension, and WC and BMI were the best predictors for low HDL-C

Probiotic yogurt affects Pro- and anti-inflammatory factors in patients with inflammatory bowel disease

Inflammatory bowel disease [IBD] is an irregular response of immune system accompanied with different inflammatory manifestations including alterations in cytokines. Probiotics are non-pathogenic organisms with probable effects in various conditions such as inflammation. The present study hypothesized whether oral intake of bifidobacterium and lactobacillus in form of probiotic yogurt may represent an immunomodulatory effect in IBD patients. Overally, 210 patients in remission phase and 95 healthy people were recruited. Patients were randomly divided into two groups of either 250 grams of probiotic yogurt [PI] or 250 grams of plain yogurt [PC] daily for 8 weeks. The healthy control group [HG] also received probiotic yogurt as noted. The serum levels of cytokines TNF-alpha, IL-6, IL-1beta, IL-10 and CRP levels were measured at baseline and at termination time. A significant difference was observed between intervention groups of PI and PC with HG group [p < 0.05]. After the intervention, serum levels of IL-1beta, TNF-alpha and CRP were significantly decreased in PI group compared to their baseline values and intervention groups. The serum levels of IL-6 and IL-10 increased significantly after the intervention compared to baseline values and PC levels [all p-values < 0.05]. Intestinal homeostasis is a balance between pro and anti-inflammatory responses of intestinal immunocytes and could be maintained by probiotics

Is household food insecurity associated with overweight/obesity in women?

Despite reports on association between overweight/obesity among women and household food insecurity [FI] in developed countries, such association is not evident in developing countries. This study aimed to assess the association between household FI and weight status in adult females in Tehran, Iran. In this cross-sectional study, 418 households were selected through systematic cluster sampling from 6 districts of Tehran. Height and weight were measured and body mass index [BMI] was calculated. Socio-economic status of the household was assessed by a questionnaire. Three consecutive 24-hour diet recalls were completed. FI was measured using adapted Household Food Insecurity Access Scale. Logistic regression was used to test the effects of SES and food security on weight status, simultaneously. Using Structural Equation Modeling [SEM] potential causal relationships between FI and weight status was explored. Only 1.0% of women were underweight, while 40.3% were overweight and 33% were obese, respectively. Severe, moderate, and mild food insecurity was observed in 11.5, 14.7, and 17.8%, respectively. Among women in moderately food insecure households, the possibility of overweight was lower than those of food secure households [OR 0.41; CI95%:0.17-0.99], while in severely food insecure households, the risk of abdominal obesity for women was 2.82 times higher than food secures [CI95%:1.12-7.08] [P<0.05]. SEM detected no causal relationship between FI and weight status. Association of severe food insecurity with abdominal obesity in adult females of households may indicate their vulnerability and the need for tailoring programs to prevent further health problems in this group

Evaluation of rubella IgG antibodies among women at marriage in Kermanshah city, before and after mass vaccination

Rubella is a mild viral infectious disease, usually occurs subclinically without a serious complication. But if occurs during pregnancy, specially the first trimester, it can transmit and invade to fetus causing congenital rubella syndrome or fetal death. In 2003, nearly all Iranians at the age of 5 to 25 years old were vaccinated against rubella and the vaccine was included in the compulsory immunization, MMR afterwards. This study was carried out on girls attended at a marriage consultancy center in Kermanshah city [West of Iran] in 2006. Considering 95% of confidence, the sample size was estimated at 140. All samples were tested using ELISA serologic method and compared with similar study conducted on 240 unvaccinated girls at the same place in 1999. Antibody positivity was observed in 99.3%, compared to 79.58% of the previous study. A rise of 19.72% [95% CI 12.7%-26.7%] of seropositivity was observed in vaccinated girls versus unvaccinated ones [P < 0.001]. In our previous study, we had recommended to screen for susceptibility to rubella before marriage, which is no longer required since more than 99% of vaccinated girls showed immunity at the time of marriage. However, as sustainability of immunity after rubella vaccination is usually less than immunity due to illness, we recommend screening for rubella protective antibody every few years

Effect of strength training and short-term detraining on muscle mass in women aged over 50 years old

The loss of muscle mass is associated with aging. The aim of this study was to determine the effects of resistance training and detraining on muscle mass in elderly women. Twenty post-menopausal women aged >/= 50 years old were enrolled. Matching for age, they were randomly assigned into control and resistance training group [RT]. The intervention consisted of three sets of 10 repetitions for 10 movements with Thera-Band tubing [based on 80-100% 10-RM], three times a week, for 12 weeks and thereafter, four weeks detraining. Skinfold thickness was determined by caliper. Percentage of body fat was estimated from skinfold thickness [triceps and subscapular] by McArdle method. Fat mass [FM] and fat-free mass [FFM] were calculated. Range of motion for trunk flexion and extension was determined. During 12 weeks of intervention, significant increases were observed in 1-RM of biceps curl, FFM, trunk flexion and extension and significant decreases during four weeks detraining in RT group. The RT group demonstrated significant decreases during resistance training and increases during detraining in skinfold thickness. FFM, trunk flexion, and extension decreased and skinfold thickness,%FM, and weight of body fat increased in the control group [P < 0.05]. Resistance training with Thera-Band enhanced strength and muscle endurance in elderly women and a 4-week detraining period had an adverse effect on muscle power. This suggests that a strength training program is an effective intervention to prevent functional reductions, and can contribute to improve neuromuscular function in older adults

[Prevalence of female sexual dysfunction and its correlated factors: a population based study]

Objective [s]: To determine the prevalence of sexual dysfunction and its effective factors in a community based study among reproductive aged women

Methods: In the present study, 784 married women, lived in urban area of Ghazvin, Golestan, Kermanshah and Hormozgan provinces, were recruited using stratified, multistage probability cluster sampling method. The sexual dysfunction was assessed using a standard questionnaire

Results: The study results demonstrated that 27.3% of women had various degrees of sexual dysfunction; 0.8%,% 20.3% and 6.3% of women had sever, moderate and mild dysfunction, respectively. Sexual desire, sexual arousal and lubrication were disturbed in 35.6%, 39.9% and18.9% of women, respectively. Furthermore 27.3% of women had orgasm's problem and 15.2% of participants were unsatisfied with sexual activity, dyspareunia was reported by 56.1% of women. There is a statistical significant relationship between sexual dysfunction with duration of the marriage, the level of attractiveness in the perspective of the husband, the overall satisfaction of common life and the ability for sexual expression

Conclusion: Sexual dysfunction is prevalent among Iranian women, as a result providing its educational facilities and counseling center is a priority for women's health

Long-term continuous methimazole or radioiodine treatment for Hyperthyroidism

There is no general agreement as to which treatment is best for hyperthyroidism. The objective of this study is to investigate the effectiveness of continuous methimazole [MMI] treatment and to compare the results of neuropsychological testing in patients receiving long-term continuous MMI to those on replacement thyroxine following radioiodine-induced [RAI] hypothyroidism. We enrolled 239 patients with diffuse toxic goiter who had recurrences of hyperthyroidism. Of these, 104 patients were randomized into two groups, MMI and treatment with thyroxine following RAI hypothyroidism. The remaining 135 patients voluntarily enrolled into either of the two groups. From all patients, 59 MMI-treated patients and 73 patients in the RAI group completed follow up. Thyroid function tests, serum lipids and lipoproteins, echocardiography, bone mineral density [BMD] and seven neuropsychology tests were performed at the final visit. In the RAI group compared to the MMI-treated group during a mean of 14 years follow up, there were more incidences of elevated TSH [> 5 mU/L; adjusted relative risk [RR] 1.23; 95% confidence interval [CI] 1.04-1.47], increased triglycerides [> 150 mg/dL; RR 2.20; 95% CI 1.34-3.62], HDL-C [< 40 mg/dL; RR 3.46; 95% CI 1.40 - 8.53], and early diastolic annular velocity [< 12.2 cm; RR 3.91; 95% CI 1.42-10.74], in addition to a decreased early diastolic to annular velocity ratio [< 6.7; RR 7.14; 95% CI 1.38-34.48]. The MMI group scored better in neuropsychology tests that included mood, direction, logical memory, repeated numbers, and intelligence quotient [IQ]. Long-term MMI treatment was superior to RAI therapy in patients with diffuse toxic goiter when mood, cognition, cardiac function and occurrence of thyroid dysfunction were compared

[Association between C-reactive protein and high-density lipoprotein of cholesterol among adults in Tehran city]

In the present research, the association between C-reactive protein [CRP] and high-density lipoprotein of cholesterol [HDL-C] is studied among healthy adults in Tehran city. It is performed as a cross-sectional study using data of adults with age 18 and more enrolled in the first phase of the "Evaluation of novel risk factors of NCD" project in the Research Institute for Endocrine Sciences [Tehran, Iran] in 2001. Analyses were done by logistic regression models using crude and adjusted odds ratio [OR] to demonstrate the associations between CRP and HDL-C regarding their age, gender, body mass index and smoking status as underlying variables. To get final reduced logistic model we used backward elimination strategy with likelihood ratio test. Based on the findings of analysis on data of 126 men and 208 women, it was reported a significant association between blood concentration of CRP and HDL-C [P<0.001]. Logistic regression analysis revealed that increasing the concentration of CRP to 0.2 mg/l and more in serum, increased the likelihood of decreasing the serum concentration of HDL-C to 40 and 50 mg/dl and less about two folds in men and women respectively [adjusted OR: 2.25, 95% CI: 1.49-3.41]. In apparently healthy adults from Tehran city, independent of age, sex, body mass index, blood pressure, fasting blood sugar, and smoking, serum concentrations of CRP and HDL-C are reversely associated while both of them are considered as independent factors related with cardiovascular disorders and complications

Comparison of anthropometric and biochemical indices of adolescents born during and after the Iran-Iraq war; Tehran lipid and glucose study

Background: a country's developmental progress and overall changes in socio-economic structure are reflected in the outcome of secular trend studies on physical growth of children. The aim of this study was to compare anthropometric and biochemical indices of adolescent boys and girls born during and after the Iran-Iraq war

Methods: adolescents, aged 11 - 18 years, were selected from the TLGS cohort and divided into two groups. In the first group, adolescents born during the war and in the second group adolescents born after the war were included. Height, weight, serum lipids, FBS, systolic and diastolic blood pressure, and BMI were compared amongst adolescents of the same ages between the two groups

Results: mean weight and height increased at the ages of 12, 13, 14, and 17 years in boys of the post-war group. The mean weight of girls in the post-war group increased at the ages of 11, 13, and 14 years. Between 11 - 14 years, the means for total and LDL cholesterol, and between the ages of 15 - 18 years FBS, total cholesterol and LDL cholesterol decreased in boys of the post-war group. For girls between the ages of 11 - 14, FBS, total cholesterol, TG and LDL cholesterol, and between the ages of 15 - 18 years, FBS, total cholesterol and LDL cholesterol decreased in the post-war group. Systolic and diastolic blood pressure decreased at all ages in both groups

Conclusion: this study showed that some anthropometric indices such as height and weight increased in boys who were born after the war; but in girls, the mean weight in the age groups increased. Systolic and diastolic blood pressure and some lipid profiles decreased in boys and girls of the post-war group

[Ginger extract reduces delayed gastric emptying and nosocomial pneumonia in ARDS patients hospitalized in ICU]

About 20% of patients who are hospitalized in ICU have ALI/ARDS. Their feeding is usually via enteral nutrition. Delayed gastric emptying [DGE] is a major problem in patients with enteral nutrition, and they are at increased risk for aspiration and subsequent development of pneumonia. The purpose of this study was to evaluate the effect of Ginger extract on DGE and developing nosocomial pneumonia in patients with adult respiratory distress syndrome [ARDS] who are hospitalized in intensive care unit [ICU]. In this double- blind randomized clinicl trial, thirty two ARDS patients, who were on mechanical ventilation and fed via nasogastric tube, were randomly divided two groups. Experimental group [n=16] received ginger extract, and control group [n=16] received coconut oil. The amount of feeding tolerated at the first 48 hours of feeding and within study period, nosocomial pneumonia, number of ICU free days, number of ventilator free days and morality were evaluated during 21 days of intervention. Nosocomial pneumonia was significantly less frequent in the ginger extract group [6.3% in the ginger extract group versus 31.3% in the control group. p= 0.07]. There was no significant difference between two groups in mortality rate. The mean number of ventilator free days was 11.25 +/- 4.73 days in ginger group versus 7.18 +/- 5 days in control group [p=0.02]. The mean number of ICU free days was 4.43 +/- 3.5 days in control group versus 7.06 +/- 3.2 days in ginger group [P=0.04]. This study showed that gastric feed supplementation with ginger extract might reduce DGE and help to reduce the incidence of ventilator associated pneumonia [VAP] in ARDS patients

Risk assessment of workers exposed to crystalline silica aerosols in the East Zone of Tehran

The term "crystalline silica" refers to crystallized form of SiO2 and quartz, as the most abundant compound on earth crust, is capable of causing silicosis and lung cancer upon inhaling large doses in course of occupational exposure. In this study, airborne respirable dust samples were collected on mixed cellulose filters [25 mm diameter, 0.8 mm pore size], by using a cyclone separator at the flow rate of 2.2 l/min for a maximum volume of 800 liters. Infrared absorption spectrometry was used according to the "National Institute of Occupational Safety and Health" [NIOSH] method No. 7602 for analysis of samples. Risk assessment techniques predictive of silicosis and lung cancer were employed. The geometric mean of workers' exposure to crystalline silica in ten industrial fields [stone milling and cutting, foundry work, glass manufacturing, asphalt, construction, sand and gravel mining, sand blast, ceramics, bricks and cement manufacturing] was in the range of 0.132 to 0.343 mg/m[3]. Mortality rate of silicosis was predicted to be in range of 1 to 52 per one thousand exposed individuals. Risk of lung cancer mortality in exposed workers in the east zone of Tehran based on geometric mean exposure of industrial activity and 45 years of exposure was in range of 50 to 129 per one thousand. In terms of risk assessment of silicosis mortality, cumulative exposure of 21 percent of population complied with the notion of acceptable risk. In regard to lung cancer mortality, 100 percent of the population were expected to have an unacceptable risk after 45 years of active work experience. This study is the first of its kind in Iran demonstrating a profile of exposure in different groups of workers in the east zone of Tehran's greater city, covering 5.5 million populations. Considering the total population of one hundred thousand workers exposed to quartz in east zone of Tehran and aging of the current young workforce, numerous cases of silicosis and lung cancer are forecasted in near future

[Association of liver enzymes with incident type 2 diabetes: Tehran lipid and glucose study]

Non- alcoholic fatty liver disease [NAFLD] is a pathogenic factor of insulin resistance and type 2 diabetes. On the other hand, the circulating liver enzymes including Aspartate aminotransferase [AST], Alanin aminotranferase [ALT] and Gamma glutamyl transferase [GGT] are commonly elevated in asymptomatic patients with NAFLD. As a nested case-control study, AST, ALT, GGT as well as classic diabetes risk factors, homeostatic model assessment of insulin resistance[HOMA- IR] and C-reactive protein [CRP] were measured in 133 non-diabetic subjects at baseline [68 cases and 65 controls]. Conditional logistic regression was used to calculate the odds ratio [OR] of diabetes associated with different hepatic markers. We used factor analysis for clustering of classic diabetes risk factors. In Univariate analysis, both ALT and GGT were associated with diabetes with ORs of 3.07 [1.21-7.79] and 2.91 [1.29-6.53], respectively. After adjustment for CRP and insulin, ALT and GGT were still predictive of incident diabetes. When the model was further adjusted for anthropometric, blood pressure and metabolic factors resulted from factor analysis [full model], only ALT was independently associated with diabetes [OR=3.06 [1.01-9.26]]. No difference was found between the area under the receiver operating characteristic curves of the models with and without ALT [0.820 and 0.802 respectively, P=0.4]. ALT is associated with incident type 2 diabetes independent of classic risk factors. However, its addition to the classic risk factors does not improve the prediction of diabetes

Isolation of mycobacterium and other microorganism from skin infectious in children during Bam earthquake

The Bam earthquake in southeastern Iran turned an ancient city to dust, killing thousands and destroying 80% of all infrastructures. More than 30,000 people died and It left some 100,000 people homeless. Direct contact with polluted water increases the risk of infection, particularly wound infections, cellulitis, dermatitis, conjunctivitis, and ear, nose and throat infections. The prevalence of NTM [non-tuberculosis mycobacteria] is difficult to obtain. The aim of this study was isolation of bacteria and mycobacterial agents, especially atypical species from dermal lesions of children in Bam earthquake. In this descriptive study, 88 children settled in camps in 2004 were enrolled. Samples from dermal lesions of children were obtained and transported with middle brook 7H9 and Brain Heart [BH] media to laboratory for isolation of mycobacterial agents and other bacteria. For isolation of mycobacterium, after decontamination and acid-fast staining, they had been cultured in Lewenstein-Jensen medium. Having isolated mycobacteria by differential tests their antibiotic resistance and susceptibility were studied. Meanwhile, other bacteria were identified by staining and culturing in standard media. The study population included 32 girls and 56 boys. Of 88 samples, 3 mycobacteria were isolated [3.4%] of which 2 were M. chelonae [rapidly growing] and 1 was M. scrofulaceum [slowly growing]. The most common isolated bacteria were E.coli [41%] and Coagulase negative staphylococcous [38%].Infectious disease epidemics may play a role in the post disaster period. Since atypical mycobacteria exist in soil, and some cases were reported from Iran, isolation of these microorganisms is of utmost importance especially in children after a disaster such as earthquake