This study was conducted to assess the level of intermittent preventive treatment of malaria in pregnancy (IPTp) in Rivers State, Nigeria, to identify obstacles prohibiting utilization in order to make recommendations for improved uptake and malaria control in general.
A cross-sectional study was carried out in November 2008 among 339 pregnant women and those who had delivered children in the last 1 year, using a multistage sampling method. Data were analyzed using the Epi-Info version 6.04d statistical software package and hypothesis tests were conducted to compare summary statistics at 95% significance level.
Most of the respondents (76.4%) had knowledge that malaria was caused by mosquitoes and was harmful in pregnancy. Although majority of the pregnant women (80.8%) attended antenatal care clinics, knowledge of the correct use of SP was low (32.6%) and only 62.8% took malaria preventive treatment. Of these, 58.4% took SP, while nearly a third, 31.8%, took chloroquine. Only 16.4% took their SP at the health facility directly observed by health workers according to the national guidelines. The commonest reason for not preventing malaria was that they were not sick during the period of pregnancy.
Misconceptions about IPTp persist among women known to have attended antenatal care clinics, resulting in only a minority of pregnant women receiving IPTp as recommended by national guidelines. Efforts directed at awareness creation on the new malaria prevention and treatment policy are therefore necessary to enhance the uptake of IPT in pregnancy in Rivers State. Further studies are however, needed to evaluate the knowledge and practices of health care workers on the new malaria treatment policy.
Intermittent preventive treatment; malaria in pregnancy; Nigeria
Left atrial appendage (LAA) occlusion is a treatment strategy to prevent blood clot formation in atrial appendage. Although, LAA occlusion usually was done by catheter-based techniques, especially percutaneous trans-luminal mitral commissurotomy (PTMC), it can be done during closed and open mitral valve commissurotomy (CMVC, OMVC) and mitral valve replacement (MVR) too. Nowadays, PTMC is performed as an optimal management of severe mitral stenosis (MS) and many patients currently are treated by PTMC instead of previous surgical methods. One of the most important contraindications of PTMC is presence of clot in LAA. So, each patient who suffers of severe MS is evaluated by Trans-Esophageal Echocardiogram to rule out thrombus in LAA before PTMC. At open heart surgery, replacement of the mitral valve was performed for 49-year-old woman. Also, left atrial appendage occlusion was done during surgery. Immediately after surgery, echocardiography demonstrates an echo imitated the presence of a thrombus in left atrial appendage area, although there was not any evidence of thrombus in pre-pump TEE. We can conclude from this case report that when we suspect of thrombus of left atrial, we should obtain exact history of previous surgery of mitral valve to avoid misdiagnosis clotted LAA, instead of obliterated LAA. Consequently, it can prevent additional evaluations and treatments such as oral anticoagulation and exclusion or postponing surgeries including PTMC.
Left atrial appendage clot; left atrial appendage occlusion; mitral valve replacement; percutaneous trans-luminal mitral commissurotomy; trans-esophageal echocardiography
Epidemiological data pertaining to maternal mortality is valuable in each set up to design interventional programs to favourably reduce the ratio. This study was done to evaluate the maternal mortality rate in our hospital, to assess the epidemiological aspects and causes of maternal mortality, and to suggest recommendations for improvement.
This was a 10 year retrospective study. Epidemiological data was collected from the hospital register and maternal mortality ratio, epidemiological factors and causes affecting maternal mortality were assessed.
A total of 120 maternal deaths occurred. Most maternal deaths occurred in the age group of 20–24 years, multiparous women (56.66%), women from rural areas (69.16%), illiterate women (65%), unbooked patients (83.33%), and patients of low socioeconomic status (83.33%). Direct causes accounted for 72.5% of maternal deaths where as 27.5% of maternal deaths were due to indirect causes.
There is a wide scope for improvement as a large proportion of the observed deaths are preventable.
Maternal mortality ratio; maternal mortality; prevention
Metabolic syndrome is a major risk factor for coronary artery disease (CAD).
Aim of this study was to determine the prevalence of metabolic syndrome in patients with premature myocardial infarction (before 50 years of age).
In this case–control study, we compared 98 consecutive patients who were hospitalized in Birjand with acute first myocardial infarction before the age of 50 years and 98 age- and sex-matched healthy controls without a history of coronary artery disease. The case and control groups were categorized according to the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) metabolic syndrome criteria [presence of ≥3 of the following: Fasting blood glucose ≥100 mg/dL, triglyceride (TG) level ≥150 mg/dL, low high density lipoprotein (HDL; <40 mg/dL in men and <50 mg/dL in women), blood pressure ≥130/85 mm Hg, and waist circumference >102 cm in men or 88 cm in women]. The data were collected and analyzed by t-test, χ2, and logistic regression in SPSS software 11.5.
Prevalence of metabolic syndrome was significantly higher in cases than in control group (34.7% in cases, 16.3% in controls, P=0.003). All components of metabolic syndrome except high waist circumstance in the cases group were significantly higher than in control. The most common component of metabolic syndrome was high TG and the least common component was low HDL.
We conclude that prevalence of metabolic syndrome in patients with premature myocardial infarction is high; high TG is the most common component of metabolic syndrome.
Case–control study; metabolic syndrome; premature myocardial infarction
Rescuer systems personnel such as firefighters have importance in health assessment. Because of stressful situation, chemicals, metals, gases and noises, they need many physical and paraclinic examination such as audiometry in periodic examinations. Comparison of sensory – neural hearing between firefighters and office workers.
A cross-sectional study had been done on firefighters and office workers with use of the clinical – health issues. Data had been analyzed in SPSS 11.5 by T-test and Chi-2 with significance level of P<0.05.
Mean of hearing threshold in firefighters’ right ear in 4000, 6000, 8000 Hz was 16.05±8.66 dB and in office workers was 15.20±6.47 dB with t=0.786 and P=0.433 had no significant difference, this mean in firefighters’ left ear was 16.17±8.12 dB and in office workers was 15.52±6.67 dB with t=0.617 and P=0.538 had no significant difference too. Mean of hearing threshold in firefighters’ right ear in age 40 or less than it in 4000 Hz was 20.51±10.11 dB and in office workers was 17.50±5.28 dB with t=2.153 and P=0.033 had significant difference.
Mean of hearing threshold in firefighters in all frequencies was normal, except 4000 frequency. It showed the early effect of occupational exposure on hearing.
Chemical pollution; firefighter; sensory–neural hearing; siren
Menopause is a physiological process typically occurring in the fifth decade of life. One of the most annoying oral symptoms in this age group is the burning mouth syndrome (BMS), which may be defined as an intraoral burning sensation occurring in the absence of identifiable oral lesion or laboratory findings. Pain in burning mouth syndrome may be described as burning, tender, tingling, hot, scalding, and numb sensation in the oral mucosa. Multiple oral sites may be involved, but the anterior two-third part and the tip of tongue are most commonly affected site. There is no definite etiology for BMS other than the precipitating causative factors, and it is still considered idiopathic. Various treatment options like use of benzodiazepine, anti-depressants, analgesics, capsaicin, alpha lipoic acids, and cognitive behavioral therapy are found to be effective, but definite treatment is still unknown. The present article discusses some of the recent concepts of etiopathogenesis of BMS as well as the role of pharmacotherapeutic management in this disorder.
Burning mouth syndrome; menopause; stomatodynia; oral mucosa
Flavonoids comprise a large group of plant metabolites, 6,000 of which have been identified to date. Some studies have shown the increased aerobic performance and maximal oxygen consumption (VO2max) and therefore fitness following quercetin intake as a result of elevated number of intracellular mitochondria caused by the flavonoid.
This double-blind clinical trial comprised 60 male students having an athletic history of at least 3 years. Body composition, exercise performance, and some blood biomarkers were analyzed. The individuals were selected by convenient sampling, and then were assigned into four groups of equal number by using permuted block randomization. The first to fourth groups received a 500 mg supplemental quercetin capsule plus a 250 mg vitamin C pill, a 500 mg supplemental quercetin capsule plus a 250 mg placebo vitamin C pill, a 500 mg placebo quercetin capsule plus a 250 mg vitamin C pill, and a 500 mg placebo quercetin capsule plus a 250 mg placebo vitamin C pill, respectively, daily for 8 weeks. The participants were asked to continue their routine diet and physical activity during the study and they were monitored through phone calls or text messages.
Lean body mass, total body water, basal metabolic rate, and total energy expenditure increased significantly in the quercetin group after intervention. On the other hand, VO2max increased in the “quercetin” and “quercetin + vitamin C” groups following the intervention, non-significantly.
Our findings suggest that supplementation with quercetin in athletes may improve some indices of performance.
Athletes; quercetin; body composition; exercise performance; muscle damage
Gender-based violence is recognized as a major issue on international human rights agenda. Domestic violence and abuse can happen to anyone, yet the problem is often overlooked, excused, or denied. This is especially true when abuse is psychological, rather than physical.
A community-based cross-sectional study of 6 months duration was undertaken with the objective of studying the proportion and different forms of domestic violence, factors influencing it, and to study treatment-seeking behavior of these women. The study participants were married women in the age group 18–45 years residing in an urban slum area of Malwani, Mumbai. Using stratified random sampling, 274 subjects were selected. House to house visits were paid and they were interviewed face to face using a pretested semi-structured questionnaire after obtaining their informed consent. Rapport was established with the help of a Medical Social Worker. The questionnaire included information pertaining to the sociodemographic parameters and experience of domestic violence in the last 1 year and their treatment-seeking behavior for the same. Utmost care was taken to maintain privacy and confidentiality. Analysis was done using SPSS version 17.
The proportion of domestic violence was 36.9%. The most common form of violence was verbal in 87 (86.1%) followed by physical in 64 (63.4%).
A significant association was found between domestic violence and age, education, spousal alcoholism, and duration of marriage.
Community-based study; domestic violence; spouse; treatment-seeking behavior
Following the entrance of new technologies in health information era, this study aimed to assess changes in health information sources of Iranian people during past decade.
Totally 3000 people were asked about their main sources of health information. They were selected as two community-based samples of 1500 people of more than 18-years-old in two different periods of time in August 2002 and August 2010 from the same locations in Tehran, the capital of Iran. Data analyzed based on age group, sex, educational level and household income in two different periods of time using Chi-square. Odds ratios associated with each basic characteristic were calculated using logistic regression.
Most common sources of health information in 2002 were radio and television (17.7%), caregivers (14.9%) and internet (14.2%) and in 2010 were radio and television (19.3%), internet (19.3%) and caregivers (15.8%) (P < 0.001). In 2010, young adults female used television and radio and male used internet as the main source of health information (P = 0.003). In moderate educational level women got their health information from radio and television and caregivers; while men used radio and television and internet as main source of health information (P = 0.005). Highly educated women and men mainly got their health information from internet and radio and television (P > 0.05).
Although during 8 years of study radio and television remained as main source of health information but there is an increasing tendency to use internet especially in men. Policymakers should revise their broadcasting strategies based on people demand.
Consumer health information; health policy; internet
Health-promoting lifestyle is receiving increasing attention concerning its prominent role in healthcare. This study examined to adapt the health-promoting lifestyle profile II culturally and to assess its psychometric properties.
In this cross-sectional study, content validity was established using translation and back-translation procedures, pilot testing of the instrument, and getting views of the expert panel. Concurrent validity was estimated with Pearson's correlation between the HPLP II, the quality of life (SF-12), self-efficacy variables, and demographic variables. Construct validity was evaluated by confirmatory factor analysis (CFA). Sample size for CFA included 500 people. HPLP II reliability was estimated with Cronbach's alpha coefficients.
The content validity Index (CVI) surpassed 0.80 for the HPLP II and for four subscales. The CFA four-factor model represented an acceptable fit. Their factor loadings was more than 0.40. Correlations between the HPLP II and the subscales were acceptable. The relationships between the HPLP II, self-efficacy, SF-12 domain scores, and demographic variables were also significantly positive. Cronbach's α coefficient was 0.86 for the HPLP II and for the subscales ranged from 0.70 to 0.77.
The shortened HPLP II had satisfactory psychometric properties. The revised 34-item four-factor model had perfect fit. It can be used to measure health-promoting lifestyle in the Iranian female adolescents’ population.
Adolescents; confirmatory factor analysis; reliability; validity
This study was to evaluate the effect of a period of aquatic exercise therapy on muscle strength and joints range of motion in hemophilia patients.
This was a semiexperimental, pretest, post-test study with a control group. This semi-experimental study comprised twenty men suffering moderate hemophilia were selected by convenience sampling method from patients of a referral hospital. They were randomly assigned to intervention and control groups of equal number. The hemophilia patients who were referred to Sayedo-Shohada Hospital enrolled in this study. Twenty men suffering moderate hemophilia were selected using convenience sampling method and then divided randomly into intervention and control groups (10 patients in each group). Subjects of aquatic exercise therapy group underwent activity in water in three sessions (45-60 minutes) per week for 8 weeks, while the control group was only under follow-up and during this period did not experience any effective physical activity. The patients’ muscle strength and joint range of motion were evaluated through standard laboratory tools, using an isokinetic dynamometer (Biodex, Systems III) and a standard goniometer in the beginning and at end of the study. Finally, data was analyzed using analysis of covariance (ANCOVA).
The strength of the muscles around the knee joint (to perform extension and flexion movements) increased significantly in the case group while the control group experienced a significant reduction of strength in left leg, but in right leg remarkable change was observed. Range of motion in all joints was improved in the case group, while the control group did not improve significantly.
The results showed that aquatic exercise therapy can be a useful method to improve joints’ strength and range of motion in hemophilia patients in order to improve their daily functioning and quality of life.
Aquatic exercise therapy; hemophilia; joint range of motion; muscle strength
Considering the high prevalence of congenital hypothyroidism (CH) in Isfahan and its different etiologies in comparison with other countries, the high rate of parental consanguinity, and the role of NIS gene in permanent CH due to dyshormonogenesis, the aim of this study was to investigate the G395R mutation of the NIS gene in patients with permanent CH due to dyshormonogenesis
In this case–control study, patients diagnosed with permanent CH due to dyshormonogenesis during CH screening program were selected. Venous blood sample was obtained to determine the G395R mutations of NIS gene using polymerase chain reaction (PCR) sequencing method.
In this study, 35 CH patients with permanent CH due to dyshormonogenesis and 35 neonates with normal screening results as a control group were studied. We did not find any changes of the mentioned mutation of NIS gene in the patients’ group.
Considering the findings of the current study, it seems that further studies with larger sample size and with consideration of other gene mutations such as pendrin and thyroglobulin are needed for more accurate conclusion.
Congenital hypothyroidism; dyshormonogenesis; G395R; mutation; sodium/iodide symporter (NIS) gene
Hemolytic uremic syndrome (HUS) is a heterogeneous group of hemolytic disorders. Different terminologies have been described in HUS, which are as follows: (1) D+ HUS: Presentation with a preceding diarrhea; (2) typical HUS: D+ HUS with a single and self-limited episode; (3) atypical HUS (aHUS): Indicated those with complement dysregulation; (4) recurrent HUS: Recurrent episodes of thrombocytopenia and/or microangiopathic hemolytic anemia (MAHA) after improvement of hematologic abnormalities; and (5) familial HUS: Necessary to distinct synchronous outbreaks of D+ HUS in family members and asynchronous disease with an inherited risk factor. aHUS is one of the potential causes of end-stage renal disease (ESRD) in children. It has a high recurrence after renal transplantation in some genetic forms. Therefore, recognition of the responsible mechanism and proper prophylactic treatment are recommended to prevent or delay the occurrence of ESRD and prolong the length of survival of the transplanted kidney. A computerized search of MEDLINE and other databases was carried out to find the latest results in pathogenesis, treatment, and prevention of aHUS.
Atypical hemolytic uremic syndrome; children; pathogenesis; prevention; treatment
Some angiotensin converting enzyme (ACE) inhibitors have previously been shown to be effective in migraine prophylaxis. The aim of this study was to evaluate whether Enalapril is effective in migraine prophylaxis.
In this randomized, double-blind, placebo-controlled clinical trial, the effects of 10 mg Enalapril given daily were compared with those of matched placebo in 40 migraineurs for 2 months. Response to treatment was assessed at 0, 1, and 2 months after the start of intervention according to headache parameters like frequency, severity, and duration. This trial is registered with Iranian Registry of Clinical Trials (IRCT), number IRCT138711011570N1.
A significant effect on reducing migraine attack more than 50% at first and second months (P=0.016) occurred in Enalapril group. Indeed, at the first and second months of treatment, the severities (P=0.000 and P=0.000) and duration (P=0.037 and 0.003) in the Enalapril treated group were significantly lower than in the placebo group.
Enalapril may be effective in migraine prophylaxis according to its effect in decreasing the frequency, severity, and duration of headaches. The results support the previous suggestions on usage of ACE inhibitors in migraine prophylaxis.
Angiotensin converting enzyme inhibitors; Enalapril; migraine disorders
Research on attachment has shed new light on understanding one of the underlying mechanisms of psychopathology in children. The aim of this study was to investigate the therapeutic efficacy of attachment-based intervention in a pediatric sample with obsessive-compulsive disorder (OCD).
Twelve participants, 10-12 years of age, were treated across an eight-week period. They had not been treated with either pharmacotherapy or psychotherapy previously and remained medication-free during the attachment-based therapy. This study comprised two groups of children: The experimental group, who received attachment-based intervention, and the control group, who did not receive treatment. All participants were assessed in terms of severity of OCD symptoms by administrating the Children's Yale-Brown Obsessive-Compulsive Scale before and after the experimental group had received the therapeutic sessions. The children were assessed again one month later. The level of children's depression, and attachment insecurity, as well as their mothers’ depression, OCD symptoms, and attachment insecurity, were statistically controlled in this study.
Multivariate analysis of covariance (MANCOVA) indicated that the OCD symptoms in children decreased significantly over the course of the therapy, and this gain was maintained at follow-up. The results of this study demonstrated that the attachment-based intervention was efficacious in alleviating the OCD symptoms.
It is suggested that parental instruction in attachment-based relationships may help prevent young children from developing OCD symptoms in middle-childhood and adulthood.
Attachment-based intervention; child; obsessive-compulsive disorder; pediatrics
The aim of study is to assess the importance and challenges of Malaria elimination (ME) in Iran's health system.
Opinion of experts from Ministry of Health and Medical Education and the chancellors of medical universities affected by malaria were gathered using Focus Group Discussions and in-depth interviews. We asked them about the importance and main challenges of ME in Iran.
Main factors on importance of ME were: it's a struggle to reach to equity in the poorest regions of county, prevention of emerging disease in susceptible regions, lowering the cost of control and its effects on the region's socioeconomic condition. Main challenges were Iran's long border with malaria-endemic countries Pakistan and Afghanistan and illegal immigrants, underdevelopment in rural areas, system's insensitivity and diagnosis problem due to reduction of cases.
Quantitative and holistic researches are needed for assessing the consequences of ME.
Malaria; Prevention and control; Iran; Impact
There is scarce epidemiological data on early and asymptomatic stages of chronic kidney disease (CKD) in children, especially from developing countries. In this study, we investigated the frequency of CKD stages 3-5 among general students of Isfahan (a large province of Iran), and compared the findings with those derived from the main pediatric nephrology referral center of province.
This study was performed among 712 Isfahani school students (377 boys) aged 7-18 years, as part of the baseline survey of a national surveillance system. Blood samples were analyzed for blood urea nitrogen, creatinine, and cystatin C. Glomerular filtration rate (GFR) was calculated based on two 2009 Schwartz equations (the “updated” and the “new” equations). CKD was defined as GFR <60 ml/min/1.73 m2. Additionally, a retrospective analysis of clinical records of children with stages 3-5 CKD referred to main referral center of province from November 2001 to December 2011 was made.
The mean age of students was 12.2 ± 2.4 years. In students’ screening, the frequency of CKD was 1.3% and 1.7% based on the updated Schwartz and the new Schwartz equation, respectively. The referral center survey revealed an annual incidence of 14.5 per million age-related population (pmarp), and a prevalence of 118.8 pmarp in our province.
The prevalence of asymptomatic and undetected low GFR in Iranian children is higher than what is reflected from the reports of referral centers. Simple screening programs like annual urinalysis among high-risk school students should be considered.
Children; chronic kidney disease; cystatin C; epidemiology; Iran
Type 2 diabetes mellitus is a complex disease and a chronic health-care problem. Nowadays, because of alteration of lifestyle such as lack of exercise, intake of high fat diet subsequently obesity and aging population, the prevalence of diabetes mellitus is increasing quickly in around the world. The international diabetes federation estimated in 2008, that 246 million adults in worldwide suffered from diabetes mellitus and the prevalence of disease is expected to reach to 380 million by 2025. Although, mainly in management of diabetes focused on hyperglycemia, however, it is documented that abnormalities of angiogenesis may contribute in the pathogenesis of diabetes complications. Angiogenesis is the generation of new blood vessels from pre-existing ones. Normal angiogenesis depends on the intricate balance between angiogenic factors (such as VEGF, FGF2, TGF-β, angiopoietins) and angiostatic factors (angiostatin, endostatin, thrombospondins). Vascular abnormalities in different tissues including retina and kidney can play a role in pathogenesis of micro-vascular complications of diabetes; also vascular impairment contributes in macrovascular complications e.g., diabetic neuropathy and impaired formation of coronary collaterals. Therefore, identifying of different mechanisms of the diabetic complications can give us an opportunity to prevent and/or treat the following complications and improves quality of life for patients and society. In this review, we studied the mechanisms of angiogenesis in micro-vascular and macro-vascular complications of diabetes mellitus.
Angiogenesis; diabetes mellitus; diabetic complications; macro-vascular; micro-vascular
The main aim of this study was to assess knowledge, attitude, and practice of university faculty members and high school teachers regarding irrational antibiotic use and self-medication.
In this cross-sectional survey, 320 university teaching staff and 150 high school teachers received a questionnaire that assessed their knowledge, attitude, and practice regarding the use of antibiotics and self-medication. The reliability of the questionnaire was assessed with Cronbach's alpha internal consistency coefficient and the results were analyzed with the Mann-Whitney U test. Spearman's correlation coefficient was used to determine the correlation between knowledge, attitude, and practice.
The questionnaires were completed by 134 university faculty members and 308 high school teachers, among whom 35.8% and 47.1%, respectively, reported self-medication with antibiotics during the previous year, mostly to relieve sore throat. High school teachers were significantly better than university teaching staff in their knowledge about the effects of antibiotics and in their usage practices. In both the groups, a weak direct linear relationship was detected between attitude and practice (r=0.243, r=0.238, P<0.01) and a weak inverse linear relationship was seen between knowledge and practice (P=0.22) in the high school teacher group.
Our results showed that self-medication and the irrational use of antibiotics were common among highly educated people in a community population sample in Shiraz, Iran. The rational use of antibiotics may be favored by improving knowledge about these drugs.
Academic staff; antibiotic; attitude; knowledge; practice; self-medication
Age- and gender-specific percentiles of body mass index in children and adolescents are a cornerstone categorizing overweight and obesity in youths worldwide. Since corresponding worldwide growth curves of percent body fat (% BF) are missing, the purpose was to contribute smoothed percentiles of percentage body fat from a large urban sample of German youths and to include them in actual national and international percentile curves.
We estimated % BF in 22 113 German youths aged 3 to 18 years participating in yearly cross-sectional surveys of the PEP Family Heart Study Nuremberg between 1993 and 2007. Percentage body fat was calculated from skinfold thickness using Slaughter equations. Ten smoothed percentile curves were constructed for % BF using the LMS method significant.
The age- and gender-specific reference curves demonstrate a continuous age-dependent increase of percentage body fat from age 3 to 18 years in girls; whereas in boys, the percentile curves steeply increase from 5 to 11 years and thereafter slightly decrease. The shape of the percentile curves, the maxima among boys at puberty and the median % BF at age 18 years are consistent with most of the current growth curves. % BF in urban studies seems to be lower than in national surveys .
More than these nine studies should contribute to worldwide-standardized growth charts for % BF to better define overweight and obesity in youth.
Youths; Germany; international comparison; percentage body fat; reference curves