Disparities in cervical cancer screening participation in Iran: a cross-sectional analysis of the 2016 nationwide STEPS survey.

BACKGROUND: One of the most important concerns in every healthcare system is the elimination of disparities in health service utilization and achievement of health equity. This study aimed to investigate the disparities in cervical cancer screening participation in Iran. METHODS: A cross-sectional study was conducted using data from the National Non-Communicable Risk Factors Survey in 2016 (STEPs 2016). Data on cervical cancer screening in addition to demographic and socio-economic factors from 15,975 women aged 18 and above were analyzed. The distribution of surveyed women with regard to cervical cancer screening practice was described. Chi square and logistic regression were used to assess the association of demographic and socio-economic factors with cervical cancer screening participation. RESULTS: Overall, 52.1% of women aged 30-59 years, had undergone cervical cancer screening at least once in their lifetime. Participation rate in cervical cancer screening programs varied between provinces; ranging from 7.6% in Sistan and Baluchestan to 61.2% in Isfahan. Single marital status, illiteracy, being employed, and having no insurance coverage were associated with lower participation. Age and area of residence were insignificant predictors for participating in cervical cancer screening program. Analysis of the cervical cancer uptake rates across the socio-economic levels revealed that the service is less utilised by high income groups. CONCLUSIONS: Participation in cervical cancer screening program in Iran is not optimal and could be improved. With regard to the distribution of cervical cancer screening practice, social and geographical disparities indicate the need for further research and more comprehensive strategies in order to reduce them.

Novel Study of Model-Based Clustering Time Series Gene Expression in Different Tissues: Applications to Aging Process.

BACKGROUND: Aging is an organized biological process that is regulated by highly interconnected pathways between different cells and tissues in the living organism. Identification of similar genes between tissues in different ages may also help to discover the general mechanism of aging or to discover more effective therapeutic decisions. OBJECTIVE: According to the wide application of model-based clustering techniques, the aim is to evaluate the performance of the Mixture of Multivariate Normal Distributions (MMNDs) as a valid method for clustering time series gene expression data with the Mixture of Matrix-Variate Normal Distributions (MMVNDs). METHODS: In this study, the expression of aging data from NCBI's Gene Expression Omnibus was elaborated to utilize proper data. A set of common genes which were differentially expressed between different tissues were selected and then clustered together through two methods. Finally, the biological significance of clusters was evaluated, using their ability to find genes in the cell using Enricher. RESULTS: The MMVNDs is more efficient to find co-express genes. Six clusters of genes were observed using the MMVNDs. According to the functional analysis, most genes in clusters 1-6 are related to the B-cell receptors and IgG immunoglobulin complex, proliferating cell nuclear antigen complex, the metabolic pathways of iron, fat, and body mass control, the defense against bacteria, the cancer development incidence, and the chronic kidney failure, respectively. CONCLUSION: Results showed that most biological changes of aging between tissues are related to the specific components of immune cells. Also, the application of MMVNDs can increase the ability to find similar genes.

The Comparison of the Effects of Massaging and Rocking on Infantile Colic.

INTRODUCTION: Infantile colic is a painful condition in the first months of infancy. This study was carried out with the aim of testing the hypothesis that massage treatment has a clinically relevant effect on this condition. MATERIALS AND METHODS: This randomized clinical trial was conducted among 100 infants of < 12 weeks of age with infantile colic. They were randomly assigned to either infant massage (n = 50) or rocking groups (n = 50). In the massage group, trained individuals taught the parents of the infants the massage technique and gave them a brochure. Rocking group parents was recommended to rock their infants three times a day for 1 week. Parents recorded the pattern of crying (numbers, length, and severity of crying). After 1 week of intervention, data were analysed using t-test, Chi square test, and repeated measurement analysis of variance (P < 0.05). RESULTS: Significant differences were not observed in infant and mother demographic information. Before intervention, the mean of total number, length, and severity of crying were 6.12 (1.76) time/day, 4.97 (1.37) hour/day, and 6.60 (1.54) in the massage group and 6.96 (2.9) time/day, 3 (1.31) hour/day, and 5.98 (2.22) in the rocking group, respectively. After 1 week of intervention, the mean difference of total number, length, and severity of crying were 4.08 (1.83) time/day, 2.81 (1.77) hour/day, and 2.9 (2.37) in the massage group and 0.56 (2.28) time/day, 0.27 (1.09) hour/day, and 0.02 (1.64) in the rocking group, respectively. CONCLUSIONS: This trial of massage treatment for infantile colic showed statistically significant or clinically relevant effect in comparison with the rocking group.

Impact of vitamin supplements on HAART related hematological abnormalities in HIV-infected patients.

BACKGROUND: The human immunodeficiency virus (HIV) is one of the most life- threatening human infections. The advent of highly active antiretroviral therapy (HAART) has dramatically changed the course of HIV infection and patients' quality of life. In addition to the benefits, HAART can have numerous side effects and toxicities. Therefore, we aimed to assess the impact of short-term vitamins treatment on hematological parameters of HIV infected patients receiving HAART. METHODS: This cross-sectional study was conducted on 100 confirmed HIV positive patients who referred to Shiraz HIV/AIDS research center in southwest of Iran. The first-line of HAART regimen contained Zidovudine, Lamivudine, and Efavirenz. The studied population received vitamin B12 weekly and folic acid daily for at least one month. RESULTS: After receiving HAART for at least 6 months with adherence above 90%, significant differences (p<0.05) were observed in MCV, MCH, HCT, TLC and RBC status compared to the baseline parameters. After one month of treatment, vitamins in four hematological parameters including TLC, MCV, RBC, and WBC showed significant differences compared to HAART parameters. CONCLUSION: Combined administration of B12 and folate supplements is a beneficial adjuster on hematologic status of HIV infected persons receiving HAART. However, future research with larger studied population and longer follow-up periods is required. Moreover, especial attention should be given to gender because the effect of vitamins was significantly different on some hematologic parameters between different genders.

First Outcome of MDR-TB among Co-Infected HIV/TB Patients from South-West Iran.

BACKGROUND: Tuberculosis (TB) is the leading cause of mortality among human immunodeficiency virus (HIV) patients and the majority of them occur in developing countries. The aims of the present study were to determine the frequency of HIV/TB co-infection and other probable associated factors. METHODS: This 10 year retrospective study was conducted on 824 HIV patients in the south-west of Iran. HIV infection was diagnosed by the enzyme linked immunosorbent assay and confirmed by Western blot. TB diagnosis was based on consistency of the clinical manifestations, chest X-ray, and microscopic examination. Drug susceptibility testing was done by the proportional method on Löwenstein-Jensen media. RESULTS: Of 824 HIV patients, 59 (7.2%) were identified as TB co-infected and the majority (86.4%) of them were male. Of the overall TB infected patients, 6 cases (10.2%) showed multidrug-resistant with the mean CD4+ lymphocyte count of 163±166 cells/mm(3). The main clinical forms of TB were pulmonary (73%). There was a significant (p<0.05) correlation between TB infection and CD4+ lymphocyte counts ≤200 cells/mm(3), gender, prison history, addiction history, and highly active anti-retroviral therapy. CONCLUSION: We reported novel information on frequency of HIV/TB co-infection and multidrug resistant-TB outcome among co-infected patients that could facilitate better management of such infections on a global scale.

Colourimetric-based method for the diagnosis of spinal muscular atrophy using gold nanoprobes.

Although numerous molecular methods for spinal muscular atrophy (SMA) detection have been exploited, most of them are laborious, time consuming and costly. Recently, gold nanoparticles (AuNPs) have attracted attention in the field of colourimetric bioanalysis, because AuNP aggregation can be tracked with the naked eye as well as ultraviolet-visible (UV-vis) peak analysis. Here, based on a non-cross linking platform, a colourimetric-based method was used to evaluate the capability of thiolated oligo-AuNPs (Au nanoprobes) to distinguish between normal individuals, carriers and those with SMA. In this platform, removal of the repulsive force of the Au nanoprobes using high salt concentration solutions forced them to aggregate. Amplified DNA products from 20 blood samples were hybridised with the Au nanoprobes. UV-vis spectra and peak analysis ratios of SMA-positive samples revealed that, following salt addition, the unhybridised Au nanoprobes progressively aggregated and their absorption peak shifted to longer wavelengths (P<0.05), observed as a colour change from red to violet-purple. In contrast, colourimetric discrimination between normal and carrier samples following salt addition was not possible because of the small differences in their spectra and aggregation indices. Using this method, patients can be screened in <30 min.

Prevalence of subclinical hypothyroidism in pregnant women in tehran-iran.

BACKGROUND: Maternal subclinical hypothyroidism during pregnancy is associated with various adverse outcomes. Recent consensus guidelines advocate universal thyroid function screening during pregnancy. There are no data from Iran about the prevalence of thyroid hypofunction in pregnancy. This study aims to find the prevalence of thyroid dysfunction. MATERIALS AND METHODS: In this descriptive cross sectional study, thyrotropin (TSH) was measured in 3158 pregnant women irrespective of gestational age from October 2008-March 2012. If TSH was more than 2.5 mIU/L in the first trimester or more than 3 mIU/L in the second or third trimester, free T4 was measured to diagnose subclinical/ overt hypothyroidism. If serum free T4 was in the normal range (0.7-1.8 ng/dl) the diagnosis was subclinical hypothyroidism and if below the normal range, overt hypothyroidism was diagnosed. RESULTS: A total of 3158 pregnant women were evaluated. One hundred forty seven of them were diagnosed as hypothyroidism. Subclinical hypothyroidism and overt hypothyroidism were present in 131 (89.1%) and 16 (10.9%) women respectively. Prevalence of subclinical hypothyroidism was 4.15%. Most of the subclinical and overt hypothyroidism cases were diagnosed in the first trimester. CONCLUSION: It appears logical to check TSH during pregnancy due to the observed prevalence of subclinical hypothyroidism.

Prevalence of Ecstasy use and predisposing factors among Iranian female high school students.

OBJECTIVES: To determine prevalence of ecstasy use and its predisposing factors among Iranian high school female students in Tehran, capital of Iran. METHODS: In this cross-sectional study, 2350 female students of 36 high schools from Tehran, were selected by multi-stage cluster sampling to determine prevalence of ecstasy use and its predisposing factors. SPSS- version 13 was employed to conduct analysis through chi-square, fisher's exact test and logistic regression methods. RESULTS: The prevalence of ecstasy use was 2.3% (95% CI: 1.7-2.9%). Party was the most prevalent place of first use (65%) and access was easy for most users (63%). In multivariate analysis, smoking (P-V = 0.005), alcohol use (P-V = 003), use of other substances (P-V < 0.001), being in relationship with boys (P-V = 0.015), families without one or two parents (P-V = 0.020), night spending at friends home without parents' permission (P-V = 0.001) were associated with ecstasy use. CONCLUSION: Due to relation of ecstasy use with other substances, designed programmes should be comprehensive, with different strategies and collaboration of several sectors. The main strategies are to improve students' health literacy, family support, to limit supply and access, and to legislate appropriate regulatory laws.

Fish oil increases atherosclerosis and hepatic steatosis, although decreases serum cholesterol in Wistar rat.

BACKGROUND: It is known that fish oil consumption decreases incidence of cardiovascular disease. However, some studies showed that it increases atherosclerosis as it does not get completely metabolized by the liver. The aim of the present study was to investigate the effects of fish oil on aortic atherosclerosis, hepatic steatosis and serum lipids in rats. METHODS: Twenty pregnant Wistar rats were fed with a fish oil-containing diet or standard diet (containing soy bean oil) during pregnancy and lactation and the pups were weaned onto the same diet. Fasting blood samples, hepatic and aortic specimens were taken from pups on day 70 postnatal. Data were analyzed with SPSS software, using t-test, Mann-Whitney test and Spearman correlation coefficient. Values of p < 0.05 were considered significant. RESULTS: Medians for fatty streak in aorta of fish oil fed and soy bean oil fed pups were 1.00 and 0.00, respectively, and P value was 0.042. Also, medians for ductular cell hyperplasia of liver in fish oil fed and soy bean oil fed pups were 1.00 and 0.00, respectively, and P value was 0.014. Total cholesterol in pups fed with fish oil was 52.20 mg/dl and in pups fed with soy bean oil was 83.90 mg/dl (p < 0.00) and for low density lipoprotein cholesterol (LDL-C) values were 8.79 mg/dl and 13.16 mg/dl, respectively (p = 0.031). CONCLUSIONS: According to the results of the present study, a diet which provided 15.9% of energy from fish oil as the only source of dietary fat, induced aortic atherosclerosis as well as hepatic steatosis in Wistar rat, although it decreased total cholesterol and LDL-C.

The knowledge and attitudes of a female at-risk population towards the prevention of AIDS and sexually transmitted infections in Tehran.

BACKGROUND: The female at-risk population represents a subgroup that is both a crucial determining factor in acquired immune deficiency syndrome (AIDS) transmission and a gap in the existing literature in Iran. The objective of this study was to evaluate the level of sex workers' knowledge towards to safe procedures of sexually transmitted infection and AIDS prevention as well as attitudes towards AIDS. METHODS: A sample of 256 female sex workers working in Tehran was obtained by a variety of methods. Appropriate questions for the assessment of knowledge and attitude were developed based on previous studies. RESULTS: The mean age of the subjects was 26.8 ± 6.1 years (ranging from 16 to 45). Methods of transmission were widely recognized, despite the exception that few realized oral (23.4%) and anal (44.9%) intercourse as methods of human immunodeficiency virus (HIV) transmission. Most subjects knew that AIDS currently has no cure (81.2%) and no vaccine (73.4%). Most also acknowledged that HIV is transmissible from people who do not know they are HIV positive (59.4%), proper condom use can reduce the possibility of infection (78.1%), and so can having a single sexual partner (68.8%). Of the participants, 43.4% knew that an HIV-positive person can seem perfectly healthy. CONCLUSIONS: Knowledge towards sexually transmitted infections (STIs) and condom use is still inadequate, especially regarding risky behaviors such as anal sex, and attitudes are mainly negative. Identifying at-risk populations, HIV-positive sex workers, education and campaigns to change the attitudes towards AIDS should be regarded a high priority in Iran.

The effect of modifiable potentials on hypermethylation status of retinoic acid receptor-beta2 and estrogen receptor-alpha genes in primary breast cancer.

Epigenetic silencing of retinoic acid receptor-beta2 (RARbeta2) and estrogen receptor-alpha (ERalpha) expressions have been revealed to be important in the development of approaches for diagnosis and therapy of breast cancer. We aimed to explore the correlation of some potential factors with the hypermethylation status of RARbeta2 and ERalpha genes among Iranian breast cancer patients. The hypermethylation status was investigated in 137 dissected tissues from primary breast cancer patients through methylation-specific PCR. Overall, the methylation frequencies of RARbeta2 and ERalpha genes were observed in 36.5 and 51.1% of participants, respectively. The hypermethylated RARbeta2 was associated with younger age at diagnosis and negative family history of breast cancer. The hypermethylation of ERalpha was correlated positively with smoking, duration of estradiol exposure, ER-negativity in tumors and body mass index (at 5 years ago). The plasma levels of folate and vitamin B(12) were inversely related to the hypermethylation status of ERalpha, after controlling for covariates. The risk of ERalpha hypermethylation was increased with high plasma level of total homocysteine. In conclusion, our data provide new insights into the possible effect of some lifestyle-related factors on the aberrant methylation drift of ERalpha and RARbeta2 genes in breast cancer.

Evaluation of PCR assay in diagnosis and identification of cutaneous leishmaniasis: a comparison with the parasitological methods.

The aims of this study are to identify Leishmania species and compare and validate internal transcribed spacers (ITS) polymerase chain reaction (PCR) assay against parasitological methods for diagnosing cutaneous leishmaniasis (CL). We used the ITS-PCR, parasite culture, and microscopic evaluation of stained smears on 155 specimens from suspected cases of (CL) patients who referred to Mashhad Health Centers (northeast Iran). The PCR indicated the sensitivity (98.8%), correctly diagnosing 86 of the 87 confirmed positive specimens. Microscopy and parasite culture alone showed 79.3% sensitivity (69/87 positive) and 86.2% sensitivity (75/87 positive), respectively, while microscopy and culture in combination improved sensitivity totally to 100% (87/87). The results also revealed that Leishmania tropica species is dominant (96.5%) in the studied regions. This study suggests that both the parasitological techniques reliably were used for the diagnosis of CL, and the ITS-PCR assay without using RFLP analysis is useful for identifying Leishmania species in the area.

Sex differences in myocardial infarction events between patients with and without conventional risk factors: the Modares Heart Study.

The authors sought to determine the profile of traditional risk factors and hematologic-metabolic parameters as well as relative risk among patients with myocardial infarction (MI). This study included 594 MI patients (70.2% men and 29.8% women) and was carried out during a period of 11 years from 1994 to 2005. Patients were analyzed by sex according to selected hematologic-metabolic parameters and risk factors. The mean age, hemoglobin, hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, total cholesterol, and fasting blood glucose were significantly different (P<.05) between men and women. The mean hemoglobin and hematocrit levels in men with hyperlipidemia (HLP) and family history of MI compared with those without these risk factors were significantly different (P<.05). Relative risks of HLP, diabetes mellitus (DM), and hypertension (HTN) for women were higher than for men in all age groups. The relative risk was 6.16 times higher for women with the 3-factor HLP, DM, and HTN combination. The results of this study confirm the important role of HLP, DM, and HTN in the occurrence of MI, especially in women.

Is anemia an independent predictor of occurrence of acute coronary syndrome? Results from the modares heart study.

The authors sought to investigate whether an increase or decrease of hemoglobin (Hgb) and hematocrit (Hct) levels were a predictor of occurrence of acute coronary syndrome. This retrospective case-control study included 594 myocardial infarction (MI) patients, 596 unstable angina patients, and 590 controls who were hospitalized from 1994 to 2005. Results show that prevalence of MI based on Hgb and Hct levels in anemic patients was 17.9% and 14.0%, respectively, and in patients with high levels in the normal range was 8.8% and 20.2%, respectively. A logistic regression between MI patients and controls showed that the odds ratio and 95% confidence interval of MI for patients with low vs high Hgb and mean corpuscular volume were 0.215 (0.112-0.412) and 0.368 (0.243-0.558), respectively. Anemia was an independent predictor of occurrence of acute coronary syndrome based on Hgb, while, based on Hct, both anemia and high Hct level were predictors of occurrence of MI.