Aging and changes in adiposity indices: the impact of menopause.

PURPOSE: Aging is associated with significant changes in fat distribution and menopause may alter this process. This study aimed to investigate the longitudinal effect of menopause on changes in adiposity indices (AI). METHODS: A total number of 3876 non-menopausal women, aged > 20 years, who participated in the Tehran Lipid and Glucose study, were selected for the present study. They were followed from 1998 to 2018 at a 3-year interval and their adiposity indices were measured. Throughout the study, participants were categorized into two groups according to their menopausal status as group 1): women who reached menopause and group 2): women who did not reach menopause. The generalized estimation equation (GEE) models were used to compare the trend of changes in AIs between these two groups. RESULTS: At the end of the study, a total number of 1479 (38.2%) participants reached menopause. The odds of general obesity decreased by 5% (OR: 0.95, 95% CI: 0.90-0.99), and the odds of central obesity increased by 6% in group1 compared to group2 (OR: 1.06, 95% CI: 1.01-1.12). CONCLUSIONS: Menopause alters the impact of aging on central fat distribution. Increasing awareness of the related risk in menopausal women and their healthcare professional may prevent adverse related outcomes.

Sexual function and hormonal profiles in women with and without polycystic ovary syndrome: a population-based study.

There is no consensus regarding the impact of polycystic ovary syndrome (PCOS) and its hormonal profile on sexual function of affected women; majority of data documented are not population based and there is a lack of studies investigating the association between hormonal profiles with sexual function in women with PCOS. We aimed to compare the sexual function of PCOS women with controls in a population-based study based on their hormonal profiles. In this cross-sectional study, sexual function (using the Female Sexual Function Index (FSFI) questionnaire) and hormonal profiles were determined in 63 PCOS subjects and 216 healthy women (controls); aged 18-45 years. A comparison of PCOS women and controls showed no statistically significant difference in total FSFI and each of its specific domain scores. There were significant positive correlations between dehydroepiandrosterone sulfate and total FSFI, orgasm and satisfaction domains in controls (r=0.156, r=0.206, r=0.275, respectively). No significant correlations between hormonal profiles and FSFI scores were found in the PCOS group, except for prolactin and orgasm (r=-0.250). In conclusion, sexual function did not differ between PCOS women and controls. High levels of androgens in women with PCOS were not associated with an improvement in sexual function.

MICRODOSIMETRIC MEASUREMENTS OF A TISSUE-EQUIVALENT PROPORTIONAL COUNTER BASED ON A GAS ELECTRON MULTIPLIER DOWN TO 140 nm SIMULATED SITE SIZES.

A multi-element tissue-equivalent proportional counter (TEPC), based on a gas electron multiplier, has been constructed with several cavities of small dimensions (down to 0.5 mm of diameter), to be used for microdosimetric measurements in intense, pulsed, radiation fields. First micro- and nano-dosimetric spectra with low-energy X rays in various simulated tissue site sizes are presented. The specific advantages and the calibration methods of this type of TEPC are discussed.

The impact of oral contraceptives on cardiometabolic parameters.

PURPOSE: There is much controversy regarding the use of oral contraceptive pills (OCPs) on cardiometabolic parameters, which is why this longitudinal population-based study was conducted to assess the impact of OCP use and its duration on cardiometabolic factors. METHODS: Of 5532 reproductive-aged participants of the Tehran lipid and glucose study, 3160 women who met our inclusion criteria were subdivided according to the duration of OCPs consumption into four sub-groups: (1) Non-users; (2) <11 month users; (3) 12-35 month users, and (4) ≥36 month users, and their cardiometabolic parameters were compared. RESULTS: No statistical significant differences were observed between the cardiometabolic parameters of these sub-groups, after further adjustment for confounding factors including age, parity, and education, except for mean low-density lipoprotein-cholesterol which was significantly higher in women who used OCPs for >36 months in comparison to non-OCP users. The odds ratio of hypercholesterolemia was significantly higher in women who used OCPs for >36 months in comparison to non-OCP users; being 1.5 times higher than non-users (95 % CI 1.01-2.2). CONCLUSION: Results showed that if used for less than 3 years, OCPs have no cardiometabolic effects.

Cancer incidence appears to be rising in a small province in Islamic Republic of Iran: a population-based cohort study.

In 2006 the Iranian national cancer registry reported that Kohgiluyeh and Boyer-Ahmad, a small province located in the southern part of the country, had a low incidence rate of almost all types of cancer. In a population-based cohort study, data on 660 cases of cancer in Kohgiluyeh and Boyer-Ahmad province were analysed after ICD codes had been rechecked and duplicates removed. Over the period 2007-2009 the annual average incidence rate of all cancers rose significantly by 53.0% and 115.1% in men and women respectively. Cancers of the prostate, thyroid, bladder and soft tissues decreased over the study period. Despite the recorded rise, the incidence rates for different sites of cancer (except for skin cancer) were significantly lower compared with their corresponding national rates for 2006. The results point to improvements in the cancer diagnosis and registry in the province, although real changes in cancer incidence over the period cannot be ruled out.

Surgical menopause versus natural menopause and cardio-metabolic disturbances: A 12-year population-based cohort study.

PURPOSE: Menopausal status exposes women to increased risk of cardiovascular disease. This study was performed to compare the effect of menopausal types, including surgical and natural, on metabolic syndrome and other metabolic disorders 3 years before and after menopause. METHODS: Of 437 postmenopausal women, who participated in the Tehran Lipid and Glucose Study, 13 women with surgical menopause and 39 age-matched controls with natural menopause were selected. During the follow-up period, changes in metabolic and biochemical profiles were compared between surgical and natural menopause women. RESULTS: Odds of incidence of metabolic syndrome in surgical menopause women, compared to natural menopause women, was 9.7 (95 % CI 1.8-51.8). CONCLUSIONS: Metabolic disturbances after menopause are highly influenced by type of menopause and are more prevalent in those undergoing surgical menopause.

Does metabolic syndrome or its components differ in naturally and surgically menopausal women?

OBJECTIVES: This study aimed to compare metabolic syndrome and its components in naturally and surgically menopausal women. METHODS: This is a longitudinal study, with incident case and control groups, conducted on 446 women participants of the Tehran Lipid and Glucose Study, who experienced surgical or natural menopause over a 10-year period. In both groups, data collection was conducted using questionnaires including information on demographic, reproductive and metabolic characteristics at baseline and again after 3 years. Physical examinations and the biochemical profiles were also assessed. RESULTS: During the follow-up, metabolic syndrome was observed in 28.7% and 32.5% of the naturally menopause and surgically menopausal women, respectively. Mean fasting blood sugar and 2-h plasma glucose were significantly higher in the surgically menopause group, compared to the naturally menopause one, whereas mean systolic blood pressure was significantly higher in naturally menopausal women as compared to surgically menopause ones, after further adjustment for premenopausal status. CONCLUSIONS: Although no difference in the prevalence of metabolic syndrome in naturally menopausal women and in surgically menopausal women was found, the components of metabolic syndrome were more prevalent among those with surgical menopause.

Molecular detection and conventional identification of leishmania species in reservoir hosts of zoonotic cutaneous leishmaniasis in fars province, South of iran.

BACKGROUND: The objectives of our research were to search for Leishmania species in rodents in Fars province, south of Iran, and to compare molecular with conventional methods for detecting these parasites. METHODS: Rodents were captured using live traps and screened for Leishmania species using molecular and conventional methods, including the taking of smears from each ear. Nested PCR was employed to detect Leishmania in rodents by amplifying a region of the ribosomal RNA amplicon of Leishmania (ITS1-5.8S rRNA-ITS2) that is species-specific by DNA sequence. RESULTS: Totally, 122 rodents were captured. Leishmania parasites were detected using the nested PCR and three conventional methods (direct smear, NNN culture and Balb/C inoculation. 41 (33.6%) out of 122 rodents had Leishmania infections (34 Meriones lybicus and 7 M. persicus). All PCR products of the ITS-rDNA gene were sequenced. Sequence analysis revealed that 28 out of 41 positive samples were Leishmania major. Thirteen sequences were unreadable and therefore not identified. CONCLUSION: At least two gerbil species common in Fars ZCL foci, M. lybicus and M. persicus, are acquiring infections of L. major and may be reservoir hosts of one predominant parasite haplotype. Most infections were detected molecularly not by conventional methods, because most rodents died in the traps.

Inhibition of Murine Systemic Leishmaniasis by Acetyl Salicylic Acid via Nitric Oxide Immunomodulation.

BACKGROUND: The purpose of this study was to evaluate antileishmanial effects of ASA via NO pathway in Leishmania major infected Balb/c mice. Moreover, toxicity and pathological consequences of ASA administration were investigated. METHODS: Balb/c mice were infected with L. major and ASA was inoculated orally after lesion appearance for its ability to modulate NO and to modify Leishmania infection in host, in order to evaluate the effects of NO production on size and lesion macroscopy, delay of lesion formation and proliferation of amastigotes inside macrophages. Liver, spleen, and lymph nodes were also studied as target organs to detect amastigotes. In addition, plasma was investigated for NO induction using Griess microassay. RESULTS: ASA increased NO production in plasma of both naïve and Leishmania test groups at the ultimate of the experimental period. A decline was observed in proliferation of amastigotes inside macrophages of test group when compared with control one. ASA reduced lesion size, inhibited Leishmania visceralisation in spleen, lymph node, and decreased hepato/splenomegaly in ASA treated animals. CONCLUSIONS: Some antileishmanial effects of ASA by NO-modulation were indicated during systemic leishmaniasis in mice. Despite slight effects on lesion size, ASA decreased parasite visceralization in target organs and declined their proliferation inside macrophages. Therefore, ASA may be indicated to inhibit systemic leishmaniasis via NO pathway in mice model.

Isolation and detection of Leishmania species among naturally infected Rhombomis opimus, a reservoir host of zoonotic cutaneous leishmaniasis in Turkemen Sahara, North East of Iran.

In Iran, three species of Leishmania have been incriminated as the causative agents of human leishmaniasis, Leishmania (L.) major, Leishmania tropica, and Leishmania infantum.Rhombomis opimus have been incriminated as a principal reservoirs of the parasitic protozoan Leishmania major, the causative agent of rural zoonotic cutaneous leishmaniasis (ZCL) in Iran. Rodents captured and examined to find Leishmania species using conventional methods including direct impression smear and microscopic observation inoculation samples to Balb/c and culture in NNN medium. Also molecular method was employed to detect Leishmania in rodents by amplifying a region of the ribosomal RNA amplicon of Leishmania (ITS1-5.8S rRNA-ITS2) using Nested PCR. Leshmania species were specified by DNA sequences. 36 (38.3%) of R. opimus were Leishmania positive using at least one conventional methods. Many more ITS-rDNA fragments were amplified from R. opimus but only 65 out of 74 PCR products contained enough DNA for direct sequencing or readable sequences. The PCR assays detected in Iranian R. opimus not only Leishmania major in 59 (79.7%) rodents but also Leishmania turanica in 6 (8.1%) rodents, another parasite of the great gerbil. These parasites were found in Turkemen Sahara, North East of Iran, in a focus of rural (ZCL). L. major and L. turanica in R. opimus firmly identified from Turkemen Sahara. Nine rodents with Leishmania infections unidentified which some were unreadable sequences, these could be mixed infections of L. major, L. turanica, Leishmania gerbillisensu lato and Leishmania close to L. gerbilli or a related species reported in sandflies previously from this location. The haplotypes of L. major and L. turanica were found to be identical to that of isolates of L. major and L. turanica from Iran and in GenBank elsewhere. R. opimus is probably the key reservoir in this ZCL focus because of its abundance and its infection rates with both L. major and L. turanica.

Incidence and Mortality Rate of Common Gastrointestinal Cancers in South of Iran, a Population Based Study.

BACKGROUND: Considering the importance of updating information about incidence and mortality of common or fatal cancers and the need for studying the effectiveness of changes in the Iranian cancer registration system from pathological based to population based since 2007, the aim of this study was to provide updated population based information on incidence and mortality rates of esophagus, stomach, colon and rectum cancers in south of Iran , and also to provide basic data for investigating the performance of population based cancer registration system in these regions. METHODS: This study was a review of population based data of esophagus, stomach, colon and rectum cancers in Fars province during 2008-9.We estimated Age Standardized Incidence and Mortality Rates (ASIRs and ASMRs), truncated ASIRs and ASMRs for each cancer using direct age standardization based on Iran's population and also based on the standard population of world.Finally, considering poison distribution, we calculated standard error of incidenceand mortality rates. RESULTS: Adjusted incidence rates of esophagus, stomach, colon and rectum cancers(per 100,000) and their standard error were 2.56(0.0092), 9.99(0.0182),4.85(0.0127) and 1.56(0.0072) in males; and 1.60(0.0072), 4.66 (0.0123),3.24(0.0103) and 0.93(0.0055) in females respectively. These values for ASMRs per 100000 were 0.94(0.0056), 11.54(0.0195), 2.46(0.009), 0.34(0.0033) for men, and 0.51(0.004), 4.21(0.0117), 1.54(0.0071) and 0.41(0.0037) for women. CONCLUSION: Incidence and mortality rates of esophagus cancer in southern regions of Iran were less than the national average. We also clarified that stomach and colorectal cancers were the most important digestive cancers in this area.

Echinococcosis: an occupational disease.

Hydatidosis is a common infestation caused by Echinococcus spp. Solitary hydatid cyst of the lung is not uncommon but coexistence of two or more pulmonary cysts are less common. These cysts may drain into the bronchial tree or very rarely into the pleural cavity which causes a poor outcome. Certain people such as slaughters, tanners, stockbreeders, shepherds, butchers, veterinarians and all whose job makes them to work closely with animals are at higher risk of the infection and developing echinococcosis. Herein, we present a 14-year-old shepherd who developed severe chest pain and hydropneumothorax following a minor trauma to his chest. He had two pulmonary hydatid cysts, one of which drained to the left pleural cavity and caused the symptoms. Another cyst was complicated during his hospital course. The patient was treated surgically, received albendazole and discharged home uneventfully. A high index of suspicion is of utmost importance for the correct diagnosis and treatment of hydatid disease in hyperendemic areas and in those whose occupation might put them at a higher risk of contraction of hydatid disease.

Foley catheter entrapment resulting from the formation of a true knot in a female infant: sonographic findings.

One of the rarest complications of bladder Foley catheter insertion is knotting of the catheter. We present a case of Foley entrapment secondary to formation of a true knot at the proximal end of the catheter in a 6-month-old female infant who was referred to our center for voiding cystourethrograthy. Sonography of the bladder revealed the knotted catheter in the urinary bladder.

Nitric oxide induction as a novel immunoepidemiological target in malaria-infected patients from endemic areas of the Islamic Republic of Iran.

OBJECTIVE: Malaria has been prevalent for a long time in Iran and continues to be a health problem despite substantial control programs. In addition to numerous cytokines, nitric oxide (NO) is thought to be a key molecule and a novel target of malaria immunopathology. MATERIAL AND METHODS: The objective of this research was to measure reactive nitrogen intermediates (RNI) as stable metabolites of NO induction in plasma of malaria-infected patients in Iran. In this study, 235 blood samples from malaria patients and 80 blood samples from healthy controls were randomly collected from different malarial endemic provinces of Iran, located in southeastern (Sistan & Balouchestan, Hormozgan, Kerman) and northwestern (Ardabil) areas. The involvement of NO in malaria patients has been investigated by statistical analysis of RNI values. Griess micro assay (GMA) was used during Plasmodium vivax, P. falciparum and mixed infections, in order to evaluate whether RNI changes are related to the provincial areas, parasite strains, clinical symptoms and age and gender parameters. RESULTS: The results showed a significant increase of RNI level in malaria patients compared with the control groups of Ardabil (p<0.01), Sistan & Balouchestan, Hormozgan and Kerman (p<0.001) provinces. The level of RNI was higher in mixed plasmodial infection than in single infection. CONCLUSIONS: The high level of RNI was dependent on the type of infection, the plasmodia strain, the clinical symptoms, the age groups and the endemic provinces. Although, this study did not clarify the pathogenic and/or protective role of NO in malaria, our findings provide a novel immunoepidemiological aspect of basal NO production in patients with malaria in endemic areas in Iran.

Reversed saphenous fasciocutaneous island flap in marjolin's ulcers.

BACKGROUND: The reconstruction of the heel represents a challenge due to the limited local soft tissue availability and also due to the special structural and functional characteristics of this region. A great number of possibilities have been described; we represent a new flap for heel reconstruction which is a modified form of sural fasciocutaneous flap. METHODS: Ten patients (two female and eight male; median age 68 years, range 48-76) underwent reversed saphenous fasciocutaneous island flap after wide excision of heel lesion. The causes of heel lesions in all patients were Squamous Cell Carcinoma on the chronic burn's scar. In this new technique, sural nerve and artery were saved and blood supply to flap is based on lesser saphenous vein. Mean lesion surface was 60 cm(2) (range 30-112 cm(2)). RESULTS: Epidermolysis and flap discoloration were seen in three patients but treated with intermittent wet dressing and conservative managements. One patient showed partial necrosis in flap circumference which recovered with debridment and skin graft. Total flap necrosis was not seen in any patients. Mean hospital stay was 10 days (range 8-15 days). The mean follow up was 12 months (rang 6-18 months). CONCLUSION: Reversed saphenous fasciocutaneous island flap is an option for heel reconstruction. In contrast with sural flap, sural nerve and artery are saved.

First microdosimetric measurements with a TEPC based on a GEM.

A new type of mini multi-element tissue-equivalent proportional counter (TEPC) based on a gas electron multiplier (GEM) has been designed and constructed. This counter is in particular suitable to be constructed with a small sensitive volume so that it can be used for microdosimetry in intense pulsed radiation fields to measure the microdosimetric spectrum in the beam of, for instance, a clinical linear accelerator. The concept lends itself also for a mini multi-element version of the counter to be used for applications in which a high sensitivity is required. In this paper, we present the first microdosimetric measurements of this novel counter exposed to a 14 MeV monoenergetic neutron beam and a californium (252Cf) source for a counter cavity diameter of 1.8 mm simulating 1.0 microm tissue site size. The measured spectra showed an excellent agreement with spectra from the literature. The specific advantages of the TEPC-GEM are discussed.

Transition from open to laparoscopic fundoplication: the learning curve.

BACKGROUND: Two of us (B.C.S. and C.W.D.) began performing laparoscopic fundoplication in 1992. We have always designated the resident as the operating surgeon. OBJECTIVE: To determine the time necessary for both experienced surgeons and residents to become proficient in laparoscopic fundoplication. DESIGN: The medical records of 241 consecutive patients undergoing laparoscopic fundoplication were reviewed. This period started with the implementation of the procedure in January 1992 and ended in March 1998. For 3 consecutive years, residents were given a questionnaire regarding their confidence in performing laparoscopic fundoplication. RESULTS: Laparoscopic fundoplication was attempted in 241 patients and completed in 203 patients (84%). Comparing the first 25 attempted laparoscopic fundoplications with the second 25, there were 14 conversions (56%) vs 4 conversions (16%) (P<.01). Average operative times decreased from 236 to 199 minutes (P<.05), and the intraoperative complication rates were 5 (20%) and 1 (4%), respectively. Subsequently, the conversion rate stabilized at 2%. The operative time continued to decline to an average of 99 minutes for the last 25 laparoscopies. Senior residents and recent graduates returning the questionnaire performed an average of 112 laparoscopic procedures, including 15.7 laparoscopic fundoplications. They felt comfortable with the procedure after performing an average of 10.6 operations. CONCLUSIONS: The learning curve is very steep for the first 25 laparoscopic fundoplications for experienced surgeons. However, improvements, as judged by decreases in operative time, conversion rate, and intraoperative complications, continue to occur after 100 cases. Under supervision, residents can become comfortable with this procedure after about 10 to 15 procedures.

Comparison of outcomes of open versus laparoscopic Nissen fundoplication performed in a single practice.

BACKGROUND: We reviewed Nissen fundoplications performed in a single practice from January 1989 to March 1997, encompassing our transition from open to laparoscopic procedures. Because all operations were done by two surgeons in the same two hospitals, the study is well controlled for comparisons. METHODS: Records of 271 consecutive patients were reviewed. RESULTS: From 1989 to 1992 all patients underwent open fundoplication (n = 78). Thereafter, with increasing frequency, laparoscopic fundoplication was performed. The laparoscopic group was slightly younger (48 +/- 14 years) than the open group (54 +/- 13 years), but gender distribution and body mass index (BMI) did not differ. Mean operating time for laparoscopic cases was 163 +/- 58 minutes compared with 148 +/- 59 minutes for open cases (NS). Intraoperative complication rate was 8% for both groups. Length of hospitalization was shorter for patients undergoing laparoscopic surgery (2.4 days versus 7.2 for open procedures, P <0.05). In follow-up, 82% of the open Nissen group were asymptomatic compared with 84% of the laparoscopic Nissen group. The same proportion of patients required reoperation for dysphagia (3% for each group). Of patients who had the open procedure, 21% had wound complications. None of those treated laparoscopically had long-term morbidity from trocar insertion sites. CONCLUSION: Equal effectiveness in treating reflux combined with shorter hospitalization and absence of wound complications makes the laparoscopic approach the preferred method for performing fundoplication.