TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2019 | Volume:77 | Issue:4|Papers Count:11

Background: Staphylococcus aureus is a common pathogen in human that can be the cause of a wide range of infectious diseases including bacteremia, pneumonia, cellulitis, and osteomyelitis and skin and soft tissue infections. The coagulase enzyme is one of the most important virulence factors of this bacterium. The polymerase chain reactionrestriction fragment length polymorphism (PCR-RFLP) Coa pattern is one of the molecular base typing methods. Molecular typing plays an important role in epidemiological studies of nosocomial infection, such as methicillin-resistant Staphylococcus aureus (MRSA) infection. The PCR-RFLP Coa gene technique provides a useful preliminary method to monitor variations in MRSA populations. We were done Coa-RFLP typing according to the method of Hookey et al., with some modifications. Methods: In this cross-sectional study, one-hundred fifty isolates of S. aureus from urine and blood samples of patients that collected from educational hospitals of Imam Hossein and Al Zahra Isfahan University of Medical Sciences, Iran, from February 2018 to October 2018 were analyzed. After bacterial confirmation of isolates by Coa gene in polymerase chain reaction (PCR) technique, to perform coagulase gene typing, the repeated units encoding hypervariable regions of the coagulase gene of S. aureus were amplified by PCR. This was followed by AluI restriction enzyme digestion and analysis of restriction fragment length polymorphism (RFLP) patterns. Results: Of 150 samples, 45 isolated of S. aureus were confirmed by biochemical methods. Of previous positive samples, 36 (80%) isolates carried Coa gene. Two different genotypes of Coa gene were obtained that include bp680 fragment in 20 specimens and bp750 fragment in 16 specimens. After enzymatic digestion by AluI restriction enzyme for RFLP, four different restriction patterns were obtained that including, the 280+400 pattern in 16 specimens (44. 4%), 280+470 pattern in 7 specimens (19. 4%), 340+340 pattern in 6 specimens (16. 6%) and 750 patterns without digestion were in 7 specimens (19. 6%). Conclusion: Using the present experiments, it was determined that the PCR-RFLP pattern, 280+400, was the dominant pattern in the Staphylococcus aureus samples isolated in Isfahan.

Background: Tuberculosis (TB) is an important infectious disease with high mortality in the world. None of the countries stay safe from TB. Nowadays, different factors such as co-morbidities, increase TB incidence. World Health Organization (WHO) last report about Iran's TB status shows rising trend of multidrug-resistant tuberculosis (MDR-TB) and HIV/TB. More than 95% illness and death of TB cases are in developing countries. The most infections are in South East Asia and West Pacific that 56% of them are new cases in the world. The incidence is actually new cases of each year. Incidence prediction is affecting TB prevention, management and control. The purpose of this study was to designing and creating a system to predict TB incidence by time series artificial neural networks (ANN) in Iran. Methods: This study was a retrospective analytic. 10651 TB cases that registered on Iran’s Stop TB System from March 2014 to March 2016, were analyzed. Most of reliable data used directly, some of them merged together and create new indicators and two columns used to compute a new indicator. At first, effective variables were evaluating with correlation coefficient tests then extracting by linear regression on SPSS statistical software, version 20 (IBM, Armonk, NY, USA). We used different algorithms and number of neurons in hidden layer and delay in time series neural network. R, MSE (mean squared error) and regression graph were used for compare and select the best network. Incidence prediction neural network were designed on MATLAB® software, version R2014a (Mathworks Inc., Natick, MA, USA). Results: At first, 23 independent variables entered to study. After correlation coefficient and regression, 12 variables with P≤0.01 in Spearman and P≤0.05 in Pearson were selected. We had the best value of R, MSE and also regression graph in train, validation and tested by Bayesian regularization algorithm with 10 neuron in hidden layer and two delay. Conclusion: This study showed that artificial neural network (ANN) had acceptable function to extract knowledge from TB raw data; ANN is beneficial to TB incidence prediction.

Background: Dermatophytes create the most common fungal disease in humans, called dermatophytosis. The two species of Trichophyton rubrum and Trichophyton interdigital are responsible for over 80% of types of dermatophytosis. So far, several morphological and physiological methods have been used to differentiate these very similar species, but these methods are generally time-consuming and have low specificity. The purpose of this study was to introduce a simple and rapid duplex polymerase chain reaction (PCR) reaction to differentiate these two species from each other. Methods: This research was an analytical and experimental study that was carried out from 2017 to 2018 in the Medical Mycology Laboratory, School of Public Health, Tehran University of Medical Sciences, Iran. For this purpose, the nucleotide sequences of the 4 regions of internal transcribed spacer (ITS), beta-tubulin, elongation factor 1 alpha and calmodulin in the two considered species of fungi were conducted bioinformatics analysis. The differences and similarities of nucleotides between two species in each of these genes were studied for selecting the primer. The specificity of selected primers was tested for duplex PCR reaction against sequenced isolates of dermatophyte species. Results: According to the total data, the specific primers were selected from elongation factor 1 alpha gene. These primers produced a product of 173 and 384 bp, in Trichophyton rubrum and Trichophyton interdigital, respectively. They had high specificity in the face of various dermatophytes. The length of nucleotide sequences found in the genebank of this gene in the two species is between 700 and 770 bp. The similarity of the two species in this region is 94. 6% and differs by 78 bp. Of the 107 extracted DNAs from clinical dermatophyte isolates, in duplex PCR 24 isolates were positive with Trichophyton interdigital primer and 71 isolates against Trichophyton rubrum. The remaining isolates, which included 6, were negative in this reaction, which included other dermatophyte species. Conclusion: This method is a specific and fast differential method compared to conventional methods for identifying Trichophyton rubrum and Trichophyton interdigital from each other.

Background: Anemia is one of the most important nutritional disorders among children and adolescent in Iran and developing countries. Despite the possibility of anemia prevention, there is a high proportion of this problem in school children and especially infants. The aim of this study was to determine the prevalence rate of anemia in 6 to 12 months old children. Methods: This was a cross-sectional study that conducted between May 2016 and October 2016 in Tabas health centers, South Khorasan, Iran. In this study 911 infants aged 6 to 12 months were enrolled by census method. Demographic variables and all blood factors were collected through interviews and laboratory tests in Tabas health centers, respectively. In this study, cut-off point of <11 g/dl for hemoglobin was considered as anemia index. All Statistical analyses were done using descriptive statistics, chi-square tests and Pearson correlation in SPSS software, version 22 (SPSS Inc., Chicago, IL, USA). P-value of 0. 05 was considered as level of statistical significance. Results: The mean age of individuals was 9± 1. 5 months, the mean current weight and the mean weight at birth time were 8678± 1112. 1 g and 3090± 467. 9 g, respectively. According to World Health Organization (WHO) criteria, the prevalence rate of anemia in Tabas City was estimated 37. 1%. The prevalence rate of anemia in age groups based on hemoglobin, mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) indices had a significant decreasing trend (P=0. 001). Prevalence rate of anemia in males and females was not significantly different (P=0. 27). Moreover prevalence rate of anemia was higher in rural areas rather than urban areas (P=0. 009). Conclusion: This is the first assessment of anemia prevalence among children in east of Iran. As a result of estimated prevalence of anemia, based on WHO definition, revealed moderate public health importance among infants aged 6 to 12 months old. The deceasing trend of anemia based on age groups indicates the importance of iron supplementation in Iran, especially in developing countries.

Background: Spasticity is a common motor impairment in patients with stroke that not only has a negative impact on the patient’ s quality of life but also has high economic burdens for society. Recently the application of shock wave therapy has attracted considerable attention as a safe and effective method in treatment of spasticity. The objective of the present study was to investigate the effect of application shock wave on spasticity of quadriceps femoris and triceps surae muscles in patients with stroke. Methods: This was a quasi-experimental study on 15 stroke patients which were selected according to inclusion criteria between September 2016 and May 2017. This study was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences, Iran. The intervention included one session placebo shock wave and three sessions of true shock wave. Level of the spasticity was measured at quadriceps and gastrocnemius muscles by Ashworth scale (AS) and passive range of motion (PROM) of the knee and ankle joints was recorded by a manual goniometer (Enraf-Nonius Corp., Delft, Netherlands). Participants were assessed at baseline, after the placebo shock wave, after the final session of active shock wave and 4 weeks after the last treatment. Results: Placebo shock wave had not significant effect on grade of AS of spastic muscles as well as PROM of knee and ankle joints. True shock wave induced a statistically significant reduction in AS of triceps surae and quadriceps femoris muscles and improvement of PROM of knee and ankle joints. The reduction in AS of triceps surae and improvement of ROM ankle joint continued 4 weeks after the last treatment. However, after 4 weeks, there was a significant reduction in the PROM of knee joint compared to the last session. Conclusion: Three sessions shock wave Therapy can reduce the tone of triceps surae and quadriceps muscles and improved the passive range of motion in the knee and ankle joints for up to 4 weeks, but these effects were not stable on the PROM knee joint.

Background: Infective endocarditis occurs due to the presence of microorganisms in the endocardium or the heart valves. Nowadays, infective endocarditis is still a major cause of death with an incidence rate of 5 to 7. 9 per 100, 000 populations. The aim of the study was to determine antibiotic resistance pattern of bacterial agents isolated from blood culture of patients with infective endocarditis. Methods: In this retrospective study, infective endocarditis patients who were admitted to Sina and Ekbatan hospitals in Hamadan City, Iran, from March 2005 to February 2014, were enrolled. All demographic data, clinical manifestations, physical examinations and echocardiography reports of the patients were recorded in a check list. For all patients, blood cultures in Mueller Hinton agar and antimicrobial susceptibility testing for ceftriaxone, ceftazidime, oxacillin, cefazolin, vancomycin, imipenem, clindamycin, etc. were done by disk diffusion method. All data analyzed by SPSS statistical software, version 16 (IBM, Armonk, NY, USA). Results: A total of 61 patients with definitive infective endocarditis were included in the study, 50 of them (82%) were males and 11 patients (18%) were females. The mean age of the patients was 37. 45± 14. 79 (range 17-74) years and 37 (60. 7%) of the patients lived in urban areas. The mean duration of admission was 20± 13. 59 days. In addition, 38 patients (62. 3%) were injection drug users (IDUs) and 23 (37. 7%) non-IDU. Meanwhile, 54 (88. 5%) of them had normal valve endocarditis and 7 cases (11. 5%) had a prosthetic valve endocarditis. Moreover, the most common underlying disease in the natural valve endocarditis was rheumatoid fever (6. 6%). Blood cultures were positive in 44. 3% of the patients. The most common isolated organism was staphylococcus aureus in 15 cases (55. 55%), which had the highest resistance to oxacillin. Most patients were managed by antibiotic therapy, but 15 cases (24. 6%) underwent cardiac surgery. In follow up patients between 3 months to 9 years, 19. 7% of the patients had complete recovery and 8. 2% of them died. Conclusion: According to the findings, antibiotic resistance pattern of bacterial agents isolated from blood culture of patients with infective endocarditis was changed.

Background: Gestational diabetes mellitus (GDM) is one of the most common medical complications in pregnancy, which is associated with many serious consequences for mother and her fetus. Body mass index (BMI) in pregnant women is considered as one of most effective factor for the incidence of GDM. The aim of this study was to determine the relationship between BMI at pregnant women in the early months of pregnancy and the incidence of GDM. Methods: In this retrospective cohort study, the case of six hundred fifty-nine pregnant women who referred to health centers in Kermanshah City from September 2010 to September 2012 by convenience sampling method were selected and investigated. This study was sponsored by Kermanshah University of Medical Sciences. Height and weight were measured for each woman at the beginning of pregnancy and maternal body mass index (BMI) was calculated based on height and weight measurements. Then the pregnant women were divided into four groups based on BMI: thin (BMI less than 18. 9 kg/m2), normal (BMI between 19 kg/m2 and 24. 9 kg/m2), overweight (BMI between 25 kg/m2 and 29. 9 kg/m2) and obese (BMI more than 30 kg/m2). Those women who had diabetes at the beginning of pregnancy were excluded from the study. GDM was considered as fasting blood glucose ≥ 92 between 26-30 weeks of gestation. Results: The mean± SD age of pregnant women was 27. 7± 5. 85 year and the mean of BMI was 24. 4± 4. 0 kg/m2. The GDM was shown in 30. 7% of women. Association between BMI and GDM were statistically significant (P<0. 001). The risk of GDM onset was 1. 24 times, for each unit increase in BMI, (P<0. 001). The risk of GDM was significantly higher in overweight [OR=2. 97, CI (2. 01-4. 39)] and obese [OR=16. 89, CI (8. 46-33. 70)] women. Being underweight increased the risk of GDM onset up to 1. 19 times, but not significant. Conclusion: There is a significant relationship between maternal BMI in pregnant women at the beginning of pregnancy with GDM onset. Increased BMI is correlated with an increase in the incidence of GDM.

Background: Due to the incidence and recurrence of bladder cancer (BC), it could be categorized as a clinical and social problem that often occurs at an advanced age. This study was designed to determine the incidence of BC in Isfahan, Iran. Methods: A retrospective descriptive survey of information based on bladder cancer (ICD-O, third edition; C67) was obtained from the Isfahan Deputy of Health. The study was in conducted to the department of Urology and Kidney Transplantation Research Center and approved by the University Ethics Committee. The Isfahan Cancer Program is intended to record all cancer cases in the Isfahan. From 20 March 2016 to 19 March 2017, records with linkage to using of pathology, demographic and clinical information were recorded in Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA) and analyzed by SPSS statistical software, version 22 (IBM, Armonk, NY, USA). The incidence rates (Irs) were calculated by dividing new cases of BC during the year of study to the population at risk during the same time period×100000. Results: A total of 417 patients that corresponded to Irs of 8 per 100000 persons were studied. The overall recorded number was comprised of 361 males (IRs of 13. 9 per 100000) and 56 females (Irs of 2. 2 per 100000). The mean± SD age of patients was 64. 7± 13 years. The minimum age in males versus females was 12 versus 25 years old respectively. Age in the most patients (80% of cases) was more than 50 years old. The invasion of the muscle was recorded in 44% of cases. Geographical distribution in 65% of cases was related to Isfahan City as a place of birth-residence and in the next categories were Khomeinishahr (7. 6%), Najafabad (6. 8%), Lenjan (4. 5%), Mobarekeh (3. 7%) and Felavarjan (2. 8%) respectively. Conclusion: Comparison of bladder cancer (BC) incidence rate between the year 2014 and 2016 showed that incidence rates decreased by 18. 2%. In the 44%, invasive neoplasm of BC was recorded for the population studied. The highest frequency of BC was associated with Isfahan City and then Khomeinshahr, Najafabad, Lenjan, Mobarakeh and Falavarjan.

Background: Iron deficiency in the body is the main cause of anemia, and iron supplementation is probably the best option for iron deficiency and iron deficiency anemia in women and young children. This study aimed to explain the challenges of national iron supplementation in female school’ s base on the perspective of the stakeholders. Methods: This study was a qualitative study of content analysis. The data of this study were conducted by focus group discussion, semi-deep interviews with the participation of the target community of students, parents of students, school principals and school health instructors, general manager of the Office of Community Nutrition (Department of Education) includes manager, deputy and school health officer, from October 2016 to January 2017 in city of Gonabad, Iran. Participants were selected through targeted sampling and data collection continued to saturation. Data were analyzed using contractual content analysis method based on five steps of Graneheim and Lundman. Data management was done with NVivo software, version 11 (QSR International, Victoria, Australia), but data analysis and interpretation were done manually. Results: The findings from group discussions and semi-deep interviews with stakeholders were categorized into twelve themes. The main strength, perceived in "Perceived Individual Benefits" and "Perceived Executive or Management Benefits". The main perceived weakness was "Physical Disadvantages", "Tablets Disadvantages", "Disadvantages of Programming" and "Disadvantages of the Program". The main perceived barriers was "Educational and Information Barriers", "Barriers of Pill Consumption" and "Management and Administrative Barriers". "Modifying the Executive Program", "Individual Perception Modification" and "Reform the Shape of Pills" were suggested as a corrective mechanism from participants’ view point. Conclusion: According to the results of this study, the most important challenges of the "Schools Iron Aid National Plan" were "Educational and Information Barriers", "Administrative barriers", and "Barriers to Pill Consumption". Therefore, in order to do better, the Iron Supplementation Program requires intervention at individual, interpersonal, inter-organizational, and intra-organizational levels to provide comprehensive support for the program and, ultimately, increase program productivity.

Background: Researchers and health specialists are increasingly obtaining information on chronic illnesses from self-reports. This study validates self-reports of hypertension, based on a recently fielded survey in Mashhad City, Iran. Methods: In this cross-sectional study, we used the results of 2015 census in Mashhad City, a population based survey of people over the age of 30 (n=300745) to determine the proportion of self-reported hypertension. In this study, the data of the studied population was extracted from the databank of Sina Electronic Health Record System (SinaEHR® ) and patients with ICD10 codes including I10 and I11 approved by doctors as a reference. Finally using SPSS software, version 20 (SPSS Inc., Chicago, IL, USA) and MedCalc (https: //www. medcalc. org/calc/odds_ratio. php), sensitivity, specificity, positive predictive value, negative predictive value were calculated with 95% confidence interval. Results: Sensitivity of self-reported hypertension was 23. 92% (CI95%: 23. 43-24. 41), specificity 97. 03% (CI95%: 96. 97-97. 09), Positive Likelihood Ratio 8. 06% (CI95%: 7. 82-8. 30), Negative Likelihood Ratio 0. 78% (CI95%: 0. 78-0. 79), Positive Predictive Value 46. 34% (CI95%: 45. 60-47. 08), Negative Predictive Value 92. 25% (CI95%: 92. 20-92. 29). The self-reported sensitivity to hypertension in males, Iranian individuals, single, aged 60 and over, body mass index lower 18. 5 individual with university education was higher, which was 24. 67%, 31. 09%, 30. 07%, 32. 43% and 26. 03% respectively. Conclusion: Although the sensitivity of self-reported hypertension was poor in this study, but specificity and positive and negative predictive values were fairly good.