Is dietary vitamin B intake associated with weight disorders in children and adolescents? The weight disorders survey of the CASPIAN-IV Study.

Background: Weight disorders are highly prevalent at the global level. Vitamin B groups are clearly involved in intracellular mechanisms, energy equation, and weight gain. The present study aims to evaluate the association of dietary vitamin B intake and obesity in a large pediatric population. Methods: This cross-sectional study was conducted among children and adolescents, aged 6-18years, living in urban and rural areas of 30 provinces of Iran. The BMI-for-age classifications were as follow: percentile <0.1, (emaciated), 0.1 ≤percentile <2.35 (thin), 2.35 ≤percentile≤84.1 (normal), 84.1

Leishmania Vaccines Entered in Clinical Trials: A Review of Literature.

Leishmaniasis is considered as a zoonotic infection and neglected tropical disease. Leishmania treatment is not totally successful and imposes high expenditures, especially in developing countries. Since the natural infection leads to the robust immunity in most of the human cases, many bodies of research have been focusing on Leishmania vaccines, being capable to control Leishmania infection. First generation vaccines (such as Leishmune® and CaniLeish®) have proved robust protective immunity in dogs. In human, recombinant vaccines, including Leish-F1 could confer some degrees of protective immunity against natural infection. Recently, ChAd63-KH DNA vaccine has been accomplished in providing prevention against Leishmania infection; however, this vaccine should be further evaluated in other clinical trials.

Impact of dyslipidemia on estimated glomerular filtration rate in apparently healthy children and adolescents: the CASPIAN-V study.

BACKGROUND: Chronic kidney disease (CKD) is a leading risk factor for development of cardiovascular disease (CVD). Dyslipidemia is also known as risk factor for CVD development. However, the association of dyslipidemia with glomerular injury among healthy children and adolescents remains controversial. We aimed to investigate the relationship between estimated glomerular filtration rate (eGFR) and lipid profile risk factors among healthy children and adolescents. METHODS: In this nationwide survey, 3808 participants (1992 males, 1816 females), aged 7-18 years, were selected by cluster random sampling method from 30 provinces in Iran. Body mass index (BMI) and systolic and diastolic blood pressures were measured. Blood samples were obtained for serum creatinine, fasting blood glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) determinations. GFR was estimated using Schwartz equation. RESULTS: Girls had higher eGFR than boys (P = 0.04). In a multiple regression analysis, eGFR demonstrated a positive correlation with systolic blood pressure, BMI, fasting glucose, TC, HDL-C, and TG. By the analysis of covariance, TC, HDL-C, and TG showed a negative correlation with eGFR after adjustments for BMI, systolic and diastolic blood pressures, and fasting glucose (OR = 0.56, 95% CI = 0.29-0.89). CONCLUSION: The study showed that dyslipidemia is associated with reduced eGFR among the healthy children and adolescents.

The Relationship between Anthropometric Indices and Breast Cancer in Central Iran.

Background: Anthropometric indices have a debatable relationship with breast cancer (BC) among different ethnicity. In the current study, we have evaluated the relationship between anthropometric indices and BC in Iranian participants. Methods: Between 2012 and 2014, a total of 7,805 women were enrolled from different mammography centers in Isfahan province, Iran. For each participant, a detailed questionnaire was filled out and anthropometric indices were measured by trained technicians. We used logistic regression models to estimate odds ratios (OR) and 95% confidence interval (CI) for BC risk associated with anthropometry measurements, stratified on menopausal status. Results: In the postmenopausal group, weight ≥68 kg compared to weight <61.75 kg was associated with decreased risk of BC (OR = 0.78; 95% CI: 0.63-0.97). Postmenopausal women with Waist-Hip Ratio (WHR) ≥ 0.85 compared to WHR < 0.77 were at increased risk of BC (OR = 1.36; 95% CI: 1.07-1.73). Both premenopausal and postmenopausal women had a decreased risk of BC with higher Obesity Index (OI) and Relative Weight. Conclusion: Ethnicity appears to play an important role in the discrepancies between results of different studies about the correlation of anthropometric features with BC.

Seroprevalence of Hepatitis B Infection and Associated Risk Factors among Drug Users in Drop-in Centers of Isfahan, Iran.

BACKGROUND: Scientists perceive drug users (DUs) as a high-risk population for hepatitis B virus (HBV) infection. Effective strategies aiming at the reduction of HBV infection can be depicted when its epidemiological status is clearly defined. The present study provides new insight into associated risk factors of HBV infection and its seroepidemiological status among DUs attending drop-in centers (DICs). METHODS: This was a cross-sectional study, which was implemented in 7 DICs of Isfahan province. The sample size included 539 participants. Demographic data and risk factors for HBV infection were obtained by a trained social worker using a self-made structured questionnaire. Venous blood sample was obtained and tested for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody, and total hepatitis B core antibody (HBcAb) using enzyme-linked immunosorbent assay. RESULTS: Mean age of the participants was 31.76 ± 8.4 years. They were generally male, Iranian, urban, with an education level of high school or less. The prevalence of HBV infection (HBsAg and/or HBcAb) was 18% (88.490). Regression analysis showed that age, bloodletting, and drug injection, being the sexual partner of injecting DU (IDU), as well as frequency and duration of imprisonment positively correlated with HBV infection. CONCLUSIONS: Drug injection bloodletting, and being the sexual partner of IDU, as well as frequency and duration of imprisonment could be considered as contributing factors in HBV infection.

Evaluation of IL-12RB1, IL-12B, CXCR-3 and IL-17a expression in cases affected by a non-healing form of cutaneous leishmaniasis: an observational study design.

INTRODUCTION: Seldom cutaneous leishmaniasis (CL) may present as a lasting and active lesion(s), known as a non-healing form of CL (NHCL). Non-functional type 1 T helper (Th1) cells are assumed the most important factor in the outcome of the disease. The present study aims to assess some molecular defects that potentially contribute to Th1 impairment in NHCL. METHODS AND ANALYSIS: This prospective observational study will be implemented among five groups. The first and second groups comprise patients afflicted with non-healing and healing forms of CL, respectively. The third group consists of those recovered participants who have scars as a result of CL. Those participants who have never lived or travelled to endemic areas of leishmaniasis will comprise the fourth group. The fifth group comprises participants living in hyperendemic areas for leishmaniasis, although none of them have been afflicted by CL. The aim is to recruit 10 NHCL cases and 30 participants in each of the other groups. A leishmanin skin test (LST) will be performed to assess in vivo immunity against the Leishmania infection. The cytokine profile (interleukin (IL)-12p70, interferon (IFN)-γ, C-X-C motif chemokine ligand (CXCL)-11 and IL-17a) of the isolated peripheral blood mononuclear cells (PBMCs) will be evaluated through ELISA. Real-time PCR will determine the C-X-C motif chemokine receptor (CXCR)-3 and IL-17a gene expression and expression of IL-12Rß1 will be assessed by flow cytometry. Furthermore, IL-12B and IL-12RB1 mutation analysis will be performed. DISCUSSION: It is anticipated that the outcome of the current study will identify IL-12B and IL-12RB1 mutations, which lead to persistent lesions of CL. Furthermore, our expected results will reveal an association between NHCL and pro-inflammatory cytokines (IL-12p70, IFN-γ IL-17a and CXCL-11), as well as CXCR-3 expression. ETHICS AND DISSEMINATION: This study has been approved by a local ethical committee. The final results will be disseminated through peer-reviewed journals and scientific conferences.

Effect of Tetanus-diphtheria Vaccine on Immune Response to Hepatitis B Vaccine in Low-responder Individuals.

BACKGROUND: Conventional hepatitis B virus (HBV) vaccination fails to achieve efficient protection in about 5-10% of the world population. Hence, different strategies have been adopted to ameliorate HBV antibody titers. This study aimed to evaluate the concurrent application of tetanus-diphtheria (Td) and HBV vaccination on hepatitis B surface (HBs) antibody titer in low-responder healthy individuals. METHODS: This was a randomized clinical trial, which was implemented among 140 of medical staff working as health-care workers assumed as low-responders. The subjects were randomly allocated to either control or interventional groups. The control and interventional groups received HBV recombinant vaccine while the latter group was also vaccinated through Td. Enzyme-linked immunosorbent assay was applied to measure HBs antibody (HBsAb) titers just before and 6 months after the last vaccination. All data were entered into SPSS software. Independent t-test, paired t-test, and Chi-square or Fisher's exact test were applied for data comparison. RESULTS: Antibody titers of the subjects in the intervention and control groups soared from 49.08 ± 20.08 IU/L to 917.78 ± 204.80 IU/L and from 46.95 ± 18.55 to 586.81 ± 351.77 IU/L, respectively (both P < 0.001); nevertheless, by comparison with control group, variation of antibody titer in the interventional group was significantly higher (P < 0.001). CONCLUSIONS: Concurrent application of Td and HBV vaccine could effectively enhance protective levels of HBsAb titers in low-responder individuals.

Demographic and Clinical Findings in Pediatric Patients Affected by Organic Acidemia.

OBJECTIVE: Metabolic disorders, which involve many different organs, can be ascribed to enzyme deficiency or dysfunction and manifest with a wide range of clinical symptoms. This study evaluated some of the demographic and clinical findings in pediatric patients affected by organic acidemia. MATERIALS & METHODS: This cross-sectional study was part of a larger study conducted in patients with metabolic disorders during a period of 7 years from 2007 to 2014 in Isfahan Province, Iran. Our study covered a wide range of cases from newborn infants (one-week old) to adolescents (children up to the age of 17 years). This study evaluated patients' demographic information, history of disease, developmental and educational status, clinical and general conditions. Phone and in-person interviews were used to gather information. RESULTS: Out of 5100 patients screened in this study, 392 patients were affected by one of the different metabolic disorders and 167 individuals were diagnosed as organic acidemia. Propionic acidemia/methyl malonic acidemia (PA/MMA) was the most prevalent form of this metabolic disorder. The frequency of consanguinity was 84.7% in the group of patients. The mortality rate was 18.8% in patients with organic academia. CONCLUSION: Each of the metabolic diseases, as a separate entity, is rare; nevertheless, in aggregate they have a somewhat high overall prevalence. These diseases result in mental and developmental disorders in the absence of quick diagnosis and initiation of treatment. Furthermore, more mutations should be identified in societies affected by consanguinity. Further research should also be conducted to determine worthwhile and more-efficient screening methods as well as long term neurological prognosis.

Applications of Text Messaging, and Bibliotherapy for Treatment of Patients Affected by Depressive Symptoms.

BACKGROUND: Intensity of depressive symptoms could be exacerbated due to the paucity of appropriate treatments. We assessed the effectiveness of bibliotherapy and text messaging, which aimed at amelioration of patient's behavior and consciousness, which could lead to suicide prevention. METHODS: This was a randomized clinical trial implemented in rural health centers of Isfahan district (Iran). Health centers were assigned in three trials consisting of the booklet, text messaging, and control groups. Each group consisted of 70 patients. Inclusion criteria were being affected by depressive symptom, <18 years, and cell phone accessibility. Mental retardation, drug and alcohol abuse, visual disability, dementia, suicide attempt history, electrotherapy, and receiving psychological interventions were our not met criteria. Our patient outcomes comprised intensity of depressive symptom and treatment compliance. The first two trials were requested to study instructive booklets in 30 days while the second cohort was demanded to study the booklet in accordance with the daily delivered text messaging. RESULTS: Out of 210 individuals, 198 patients finished this study. The intensity of depressive symptom was significantly affected through time and group factors as well as time-group interaction (F = 12.30, P < 0.001). Based on treatment compliance, the interactive effect of group factor and the time factor was statistically significant. CONCLUSIONS: It seems that bibliotherapy could efficiently decrease the intensity of depressive symptoms. Nevertheless, in comparison with our booklet trial, the text messaging group achieved neither durable nor significant success; thus, bibliotherapy could be utilized as a complementary methodology aiming depression treatment.

Spatial Analysis of Neonatal Congenital Hypothyroidism and Nitrate as an Environmental Pollutant in Isfahan Province During 2010-2013.

BACKGROUND: Thyroid absorption of iodine could be encumbered by nitrate drinking water when it is transported to the fetal thyroid gland. Therefore, nitrate potentially causes congenital hypothyroidism (CH) due to thyroid dysfunction. In this study, we have not only aimed at spatial determination of CH distribution and nitrate concentration (NC) existing in drinking water, but also we intended to evaluate the probable impact of nitrate on CH incidence. METHODS: Annual average of nitrate in drinking-water as well as number of CH infants diagnosed through the screening program were applied to determine the incidence ratio of the disease for each town (from 2010 to 2013). Afterward, Arc GIS 9.3 was used to draw choropleth maps with quantile classification. Data were entered into SPSS 16.0 and Excel 2010 software. Finally, linear regression was applied for data analysis. RESULTS: The incidence rate of CH (considering transient and permanent cases) was about one in every 413 births. Khansar, Golpaygan, Naein, and Ardestan had the highest incidence rate of CH respectively. On the other hand, Tiran, Dehaghan, Khansar, and Fereydan had the highest level of nitrate drinking water. There was a strong relationship between the NC and incidence of CH in Khansar; however, this relationship was not significant (P = 0.392) in Isfahan province. CONCLUSIONS: Since there was not a significant relationship between NC in drinking-water and incidence of CH through linear regression analysis, more studies should be implemented to confirm or refute our observations.

Association of 25-hydroxy Vitamin D levels with indexes of general and abdominal obesity in Iranian adolescents: The CASPIAN-III study.

BACKGROUND: This study aimed to determine the association of serum 25-hydroxy Vitamin D (25(OH)D) levels with measures of general and abdominal obesity in Iranian adolescents. MATERIALS AND METHODS: This nationwide cross-sectional study was conducted among 1090 students, aged 10-18 years, living in 27 provinces in Iran. Serum concentration of 25(OH)D was analyzed quantitatively by direct competitive immunoassay chemiluminescence method. Body mass index (BMI) and waist-to-height ratio (WHtR) were considered as measures of generalized and abdominal obesity, respectively. RESULTS: Study participants consisted of 1090 adolescents (51.9% boy and 67.1% urban residents) with mean age, BMI, and waist circumference of 14.7 (2.6) years, 19.3 (4.2) kg/m(2), and 67.82 (12.23) cm, respectively. The median serum 25(OH)D was 13.0 ng/mL (interquartile range: 20.6). Overall, 40% of participants were Vitamin D deficient, and 39% were Vitamin D insufficient. Serum 25(OH)D level was not associated with BMI and WHtR. CONCLUSION: We did not document any significant association between serum 25(OH)D level and anthropometric measures in adolescents. This finding may be because of considerably high prevalence of hypovitaminosis D in the study population.

An overview on Leishmania vaccines: A narrative review article.

Leishmaniasis is one of the major health problems and categorized as a class I disease (emerging and uncontrolled) by World Health Organization (WHO), causing highly significant morbidity and mortality. Indeed, more than 350 million individuals are at risk of Leishmania infection, and about 1.6 million new cases occur causing more than 50 thousands death annually. Because of the severe toxicity and drug resistance, present chemotherapy regimen against diverse forms of Leishmania infections is not totally worthwhile. However, sound immunity due to natural infection, implies that vigor cellular immunity against Leishmania parasites, via their live, attenuated or killed forms, can be developed in dogs and humans. Moreover, genetically conserved antigens (in most of Leishmania species), and components of sand fly saliva confer potential immunogenic molecules for Leishmania vaccination. Vaccines successes in animal studies and some clinical trials clearly justify more researches and investments illuminating opportunities in suitable vaccine designation.

Effect of tetanus-diphtheria (Td) vaccine on immune response to hepatitis B vaccine in healthy individuals with insufficient immune response.

BACKGROUND: Hepatitis B virus (HBV) fails to produce appropriate immune responses in some healthy individuals; thus, different strategies have been adopted to promote immune responses. The current study aimed at evaluating the efficacy of HBV vaccine coadministered with tetanus-diphtheria (Td) vaccine compared with HBV vaccine in healthy individuals through measuring hepatitis B surface antibody (HBsAb) levels. MATERIALS AND METHODS: This was a randomized controlled clinical trial, which was implemented in Isfahan, Isfahan Province (Iran) in 2013. One hundred and forty healthy individuals, whose HBsAb titers were less than 10 IU/L were recruited. The subjects were randomly assigned to either in intervention or control trials. The control group received 40 µg of recombinant HBV vaccines intramuscularly injected at 0, 1, and 6 months; however, the intervention group was simultaneously vaccinated by Td with the first dose of HBV vaccine. HBV antibody levels (titer) were measured before the vaccination and 6 months after the last vaccination. RESULTS: Antibody titers of the subjects in the intervention and control groups increased from 5.07 ± 2.9 IU/L to 744.45 ± 353.07 IU/L and from 4.45 ± 3.4 IU/L to 589.94 ± 353 IU/L, respectively (both P < 0.001). Also, the mean difference of antibody titer was significantly different between the two groups (P = 0.011). CONCLUSION: Td vaccination can be applied as a feasible approach to promote efficient and persistent immunity in healthy individuals with insufficient HBsAb titers.

Frequency, Causes, and Places of Unintentional Injuries in a Nationally Representative Sample of Iranian Children and Adolescents: The CASPIAN-IV Study.

BACKGROUND: 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. METHODS: 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. RESULTS: 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%). CONCLUSIONS: Prevention of unintentional injuries should be considered as a health priority. Appropriate preventive strategies should be enhanced at homes and schools.

Comparison of the effect of surgical and medical therapy for the treatment of idiopathic granulomatous mastitis.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is defined as a rare, inflammatory, chronic and benign disease mimicking malignant hyperplasia of mammary glands. There is no definitive therapeutic strategy for IGM; nevertheless, some approaches can be exploited as beneficial strategies. In this study, the surgery strategy was compared with coincident treatment with azithromycin and corticosteroid in IGM patients. MATERIALS AND METHODS: This study was implemented as clinical trial during 2011-2013 in Isfahan, Iran. The target population comprised women whose IGM was substantiated. The medical group consisted of 20 patients, which were compared with a historical control group treated through surgical approach. Surgical group comprised 39 patients. Partial mastectomy was implemented in the surgical group whereas treatment protocol comprising azithromycin and prednisolone administered in medical group. Recurrence of mass was followed for 12 months. Fischer exact test, Chi-square test, Mann-Whitney and regression tests were applied for statistical analysis. This study was registered in Iranian Registry of clinical trial (IRCT number: IRCT 2013123015999N1). RESULTS: No significant differences were recognized in side of lesions, lymphadenopathy, fever and pain; however, number of abscesses, number of lesions and size of lesions were significantly higher in the surgical group (P < 0.0001). Furthermore, probability of relapse correlated with the number of lesions, (odds ratio = 24.67 confidence interval [CI] = 2.2-269.3), whereas methods of IGM treatment did not contribute to the likelihood of relapse (odds ratio = 12.5 CI = 0.52-299). CONCLUSION: This clinical trial demonstrated that pharmaceutical treatment has appropriate efficacy, in treatment and prevention of IGM relapse. Moreover, this study presented hazf gardad number of the lesions as the most appropriate criteria for IGM prognosis, thus the probability of relapse decreases whether earlier IGM recognizing could be implemented.