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1.  Relationship of the intake of different food groups by pregnant mothers with the birth weight and gestational age: Need for public and individual educational programs 
This study was conducted to investigate the relationship between the intake of different food groups by pregnant mothers and neonatal low birth weight and premature births.
Materials and Methods:
In this cohort, the target population was 225 pregnant women, randomly selected from different geographical areas of the city of Isfahan, Iran (from April to September, 2012). The main variables in the study were weight and gestational age of the neonates and the type and amount of different food groups used by the mothers. All nutritional variables were compared according to different groups of infants (normal, premature, and low birth weight). In the multivariate analysis, multiple linear and logistic regression models were used to identify those different food frequency questionnaire (FFQ) variables independently associated with the newborn's weight and gestational age, adjusted by maternal consumption of calcium supplementation, folic acid, and omega-3, during pregnancy.
A total of 214 (47.7% boys) infants with complete information were included. They had a mean gestational age of 38.72 ± 1.2 weeks. The mean birth weight was 3.11 ± 0.384 kg. The percentages of premature and low birth weight (LBW) infants were 7 and 5%, respectively. At multiple logistic regression controlling for potentially confounding factors that were significantly associated with prematurity and LBW at univariate analysis (maternal consumption of calcium supplementation, folic acid, and omega-3, during pregnancy), type of nutritional groups containing dairy products, proteins, fish, and shrimp group, as well as fruits and vegetables, had a significant positive association with increasing the gestational age (P < 0.05). The group that consumed proteins, fish, and shrimp, as well as fruits and vegetables had a significant positive association with the newborn's weight (P < 0.05).
This study indicated the importance of proper nutrition on reducing the rates of LBW and premature births. Comprehensive educational programs at individual and public levels are warranted in this regard.
PMCID: PMC4392531  PMID: 25883993
Education; fetal growth; health promotion; maternal nutrition; pregnancy
2.  Seasonality and Physician-related Factors Associated with Antibiotic Prescribing: A Cross-sectional Study in Isfahan, Iran 
Irrational antibiotic prescribing as a global health problem has a major influence on medical care quality and healthcare expenditure. This study was aimed to determine the pattern of antibiotic use and to assess the seasonality and physician-related factors associated with variability in antibiotic prescribing in Isfahan province of Iran.
This cross-sectional survey was conducted on all prescriptions issued by general physicians from rural and urban areas in 2011. Associations between season of prescribing and physician-related variables including gender, practice location and time since graduation with antibiotic prescriptions and also the pattern of antibiotic prescribing were assessed using Chi-square tests and multiple logistic regression models.
Of the 7439709 prescriptions issued by 3772 general practitioners, 51% contained at least one antibiotic. Penicillins were the most frequently prescribed antibiotics, followed by cephalosporins and macrolides. Over-prescription of penicillins was associated with female gender (odds ratio [OR], 2.61; 95% confidence interval [CI] 2.13–3.19) and with moderate duration of time in practice (10–20 years) (OR, 1.42; 95% CI 1.14–1.76). Higher rates of cephalosporins prescription were observed in urban areas than rural areas and by male physicians. Seasonal peak was detected for penicillins and cephalosporins prescriptions in autumn.
These findings showed the widespread use of antibiotics by general practitioners that was associated with the physicians’ gender, time since graduation and practice location and also season of prescribing. More researches are needed on other factors related to the overprescribing of antibiotics and they could be used to project educational programs for improvement of antibiotic prescribing quality in our country.
PMCID: PMC4362280  PMID: 25789136
Antibiotics; general practice; prescriptions patter; rational drug use
3.  Acute Kidney Injury in ICU Patients Following Non-Cardiac Surgery at Masih Daneshvari Hospital: Joint Modeling Application 
Tanaffos  2015;14(1):49-54.
Admission to the intensive care unit (ICU) is often complicated by early acute kidney injury (AKI). AKI is associated with high rates of mortality and morbidity. Risk factors and incidence of AKI have been notably high following non-cardiac surgery in the past decade.
The aim of this study was to determine the hazard rate of AKI, the effect of risk factors of AKI and also to assess the changes in urine output (UO) as a predictor of AKI using joint modeling in patients undergoing non-cardiac surgery.
Materials and Methods:
In this retrospective cohort study, 400 non-cardiac-operated patients admitted during 3 years to the ICU of Masih Daneshvari Hospital were selected according to the consecutive sample selection method. Random mixed effect model and survival model were used to assess UO changes and the effect of UO and other risk factors on the hazard rate of AKI using joint analysis.
AKI occurred in 8.8% of the Iranian non-cardiac-operated patients. Survival model showed that the risk of AKI in lower diastolic blood pressure (DBP), higher Acute Physiology and Chronic Health Evaluation II score (APACHE II score), emergency surgery, longer hospitalization and male patients was higher (P=0.001). Using joint modeling, an association was found between the risk of AKI and UO (−0.19, P=0.002).
Several predictors were found to be associated with AKI in the Iranian patients after non-cardiac surgery. A relationship between longitudinal and survival responses was found in this study and joint modeling caused considerable improvement in estimations compared to separate longitudinal and survival models.
PMCID: PMC4515330  PMID: 26221152
Acute kidney injury; Joint models; Risk factor; Urine output; Non-cardiac surgery
4.  Expression of cord blood cytochrome P450 1A1 gene according to the air pollution level of the maternal residence area 
This study aimed to compare the cytochrome P450 1A1 (CYP1A1) gene expression in the cord blood of infants born from mothers living in low- and high-air polluted areas.
Materials and Methods:
The study was conducted in Spring 2012 in Isfahan, the second large and air-polluted city in Iran. The study comprised 60 neonates, consisting of 30 infants born from mothers residing in areas with high levels of air pollution and an equal number of infants born in areas with a lower air pollution level. The umbilical cord blood sample was taken immediately after birth. The relative gene expression levels of CYP1A1 were examined using real time-polymerase chain reaction method.
CYP1A1 gene expression level was 3.3-fold higher in the group living in areas with higher pollution level than in the other group (P = 0.01). No significant difference existed in the mean values of maternal age, gestational age, the newborns’ birth weight, and the gender distribution between the two groups.
This study provides confirmatory evidence of prenatal health hazards of ambient air pollution and highlights the need for pollution prevention programs to protect women of childbearing age and their children. The clinical implications of this study finding should be confirmed in future longitudinal studies.
PMCID: PMC4235086  PMID: 25422651
Air pollution; CYP1A1 gene expression; fetus; prevention
5.  Association of GSTT1 and GSTM1 polymorphisms with blood pressure: A Bayesian modeling of continuous data 
Systolic blood pressure (SBP) and diastolic blood pressure (DBP) are a multi-factorial traits and significantly heritable. Glutathione S-transferase (GST) enzyme is involved in detoxification of reactive oxygen species. The present study aimed at finding out the association between GSTM1 and GSTT1 polymorphisms and mean arterial pressure (MAP) in Iranian population. MAP, as the important indicator of blood pressure, is calculated by weighted averaging of SBP and DBP.
Materials and Methods:
we randomly selected 72 healthy individuals from Isfahan Cohort Study (ICS). Polymerase chain reaction (PCR) was done to detect polymorphism of the GSTM1 and GSTT1 genes. The Bayesian Structured Regression model was used, adjusted for sex, age, body mass index (BMI), and smoking status.
The results showed that both the GSTT1and GSTM1genotypes deletion had a significant effect on MAP increasing in our samples based on 95% Bayesian credible intervals.
This study demonstrated that GSTT1 and GSTM1 gene increase the arterial pressure; hence, it can predict the susceptibility to cardiovascular disease.
PMCID: PMC4061639  PMID: 24949025
Bayesian modeling; blood pressure; GSTM1; GSTT1; oxidative stress; polymorphism
6.  Does Water Hardness Have Preventive Effect on Cardiovascular Disease? 
The aim of this study is to investigate the association of calcium and magnesium concentration of drinking water with cardiovascular disease (CVDs) in urban and rural areas of a city in Iran.
This case-control study was conducted in 2012 in Khansar County in Isfahan province, Iran. We used the official data of the Provincial health center regarding the chemical analysis data of urban and rural areas including the hardness, calcium and magnesium content of drinking water. Data of patients hospitalized for CVD in the only specialty hospital of the city was gathered for the years of 2010 and 2011.
In 2010, water calcium content above 72 mg/L was associated with reduced number of CVDs in 1000 population; whereas in 2011 this decrease in CVDs was observed for calcium levels of more than 75 mg/L. In 2010, the level of water Mg content ranged from 23 to 57 mg/L. By increasing Mg hardness level above 31 mg/L in 2010 and above 26 mg/L in 2011 were associated with decreased number of CVDs in 1000 people. decrease.
Our study suggests favorable protective effects of water hardness, mainly water magnesium content, on CVDs. Water hardness, as well as calcium and magnesium content of drinking water may have a protective role against CVDs. Further experimental studies are necessary to determine the underlying mechanisms and longitudinal studies are required to study the clinical impacts of the current findings.
PMCID: PMC3950737  PMID: 24627741
Calcium; cardiovascular disease; Iran; magnesium; water hardness
7.  Etiology of congenital hypothyroidism in Isfahan: Does it different? 
Considering the higher prevalence of congenital hypothyroidism (CH) in Iran and the importance of determination of the etiology of CH for assessing appropriate treatment strategies, understanding the pathogenesis of CH and the implications of its inheritance and prognosis, the aim of this study was to determine the etiology of CH 7 years after initiation of the program in Isfahan province.
Materials and Methods:
In this cross-sectional study, children with a primary diagnosis of CH studied. They clinically examined and their medical files were reviewed by a Pediatric Endocrinologist. Considering screening and follow-up lab data and radiologic findings the etiology of CH was determined. Screening properties of different etiologies of CH was compared.
In this study, 437 patients with permanent CH (PCH) were studied. Etiology of PCH in 316 (72.3%) and 121 (27.7%) of cases was thyroid dyshormonogenesis and thyroid dysgenesis, respectively. Prevalence of agenesis, ectopia, hypoplasia and hemiagenesis in thyroid dysgenetic patients was 13.3%, 6.4%, 4.3% and 3.7% respectively. Mean of thyroid stimulating hormone in screening, recall and after discontinuing treatment at 3 years of age was significantly lower in dyshormonogenetic CH patients than dysgenetic ones(P < 0.01).
Seven years of our experiences in CH screening program indicated that the etiology of CH in Isfahan, with a higher rate of CH, with a predominance of thyroid dyshormonogenesis is different from most of the studies world-wide and similar to other reports from Iran. The findings of the current study provide us baseline information for determination of CH pathogenesis in this region.
PMCID: PMC3929017  PMID: 24600601
Congenital hypothyroidism; dysgenesis; dyshormonogenesis; permanent
8.  Manipulating measurement scales in medical statistical analysis and data mining: A review of methodologies 
selecting the correct statistical test and data mining method depends highly on the measurement scale of data, type of variables, and purpose of the analysis. Different measurement scales are studied in details and statistical comparison, modeling, and data mining methods are studied based upon using several medical examples. We have presented two ordinal–variables clustering examples, as more challenging variable in analysis, using Wisconsin Breast Cancer Data (WBCD).
Ordinal-to-Interval scale conversion example:
a breast cancer database of nine 10-level ordinal variables for 683 patients was analyzed by two ordinal-scale clustering methods. The performance of the clustering methods was assessed by comparison with the gold standard groups of malignant and benign cases that had been identified by clinical tests.
the sensitivity and accuracy of the two clustering methods were 98% and 96%, respectively. Their specificity was comparable.
by using appropriate clustering algorithm based on the measurement scale of the variables in the study, high performance is granted. Moreover, descriptive and inferential statistics in addition to modeling approach must be selected based on the scale of the variables.
PMCID: PMC3963323  PMID: 24672565
Biostatistics; breast cancer; cluster analysis; data mining; research design
9.  Prevalence of Permanent Congenital Hypothyroidism in Isfahan-Iran 
Considering the importance to determine the reasons for the higher occurrence of congenital hypothyroidism (CH) in Iran, in this study we report the prevalence of permanent CH (PCH) in Isfahan province 7 years after initiation of CH screening program in Isfahan.
In this cross-sectional study, children with a primary diagnosis of CH studied. They clinically examined and their medical files were reviewed by a pediatric endocrinologist. Considering screening and follow-up lab data, radiologic findings and the decision of pediatric endocrinologists the final diagnosis of PCH was determined.
A total of 464,648 neonates screened in Isfahan province. The coverage percent of the CH screening and recall rate was 98.9% and 2.1%, respectively. A total of 1990 neonates were diagnosed with primary CH. PCH was diagnosed in 410 neonates. The prevalence of PCH and transient CH (TCH) was 1 in 1133 and 1 in 294 live births. The most common etiology of CH was thyroid dyshormonogenesis.
Though the prevalence of PCH is high, but the higher prevalence of CH in Isfahan is commonly due to cases with TCH. Hence, the necessity of determining new strategies for earlier diagnosis of patients with TCH is recommended.
PMCID: PMC3898441  PMID: 24498491
Congenital hypothyroidism; permanent; transient
10.  Serum Paraoxonase 1 Activity Is Associated with Fatty Acid Composition of High Density Lipoprotein 
Disease markers  2013;35(4):273-280.
Introduction. Cardioprotective effect of high density lipoprotein (HDL) is, in part, dependent on its related enzyme, paraoxonase 1 (PON1). Fatty acid composition of HDL could affect its size and structure. On the other hand, PON1 activity is directly related to the structure of HDL. This study was designed to investigate the association between serum PON1 activity and fatty acid composition of HDL in healthy men. Methods. One hundred and forty healthy men participated in this research. HDL was separated by sequential ultracentrifugation, and its fatty acid composition was analyzed by gas chromatography. PON1 activity was measured spectrophotometrically using paraxon as substrate. Results. Serum PON1 activity was directly correlated with the amount of stearic acid and dihomo-gamma-linolenic acid (DGLA). PON1/HDL-C was directly correlated with the amount of miristic acid, stearic acid, and DGLA and was inversely correlated with total amount of ω6 fatty acids of HDL. Conclusion. The fatty acid composition of HDL could affect the activity of its associated enzyme, PON1. As dietary fats are the major determinants of serum lipids and lipoprotein composition, consuming some special dietary fatty acids may improve the activity of PON1 and thereby have beneficial effects on health.
PMCID: PMC3787566  PMID: 24167374
11.  Prevalence of transient congenital hypothyroidism in central part of Iran 
Congenital hypothyroidism (CH) considered a common endocrine disorder in Iran. We report the epidemiologic findings of CH screening program in Isfahan, seven years after its development, regarding the prevalence of transient CH (TCH) and its screening properties comparing with permanent CH (PCH).
Materials and Methods:
In this cross-sectional study, children with primary diagnosis of CH were studied. Considering screening and follow-up lab data and the decision of pediatric endocrinologists, the final diagnosis of TCH was determined.
A total of 464,648 neonates were screened. The coverage percent of the CH screening and recall rate was 98.9 and 2.1%, respectively. Out of which, 1,990 neonates were diagnosed with primary CH. TCH was diagnosed in 1,580 neonates. The prevalence of TCH was 1 in 294 live births. 79.4% of patients with primary CH had TCH. Mean of screening (54.7 ± 59.0 in PCH vs 21.8 ± 28.9 in TCH), recall (56.5 ± 58.8 in PCH vs 36.6 ± 45.0 in TCH), and thyroid stimulating hormone (TSH) and mean of TSH before (2.0 ± 2.9 in PCH vs 1.6 ± 1.6 in TCH) and after (37.7 ± 29.5 in PCH vs 4.3 ± 1.9 in TCH) discontinuing treatment at 3 years of age was significantly higher in PCH than TCH (P < 0.0000).
The higher rate of CH in Isfahan is mainly due to the transient form of the disease. Further studies for evaluating the role of other environmental, autoimmune and/or genetic factors in the pathophysiology of the disease is warranted.
PMCID: PMC3872610  PMID: 24379847
Congenital hypothyroidism; permanent; transient
12.  Adiponectin gene polymorphisms and susceptibility to atherosclerosis: A meta-analysis 
Previous studies have inspected the associations between Adiponectin (ADIPOQ) 276G/T polymorphisms and atherosclerosis, but the results are inconclusive. The aim of this study was to explore the relationship between polymorphism +276 G > T (rs1501299) in ADIPOQ and atherosclerosis. A widespread search was directed to identify all studies on the association of ADIPOQ 276G/T polymorphism with atherosclerosis risk. The fixed effect pooled measures according to odds ratio (OR) and 95% confidence interval (CI) were calculated in the meta-analysis. Heterogeneity among studies was evaluated using Q test and the I2. Publication bias was estimated using modified Egger's linear regression test and Fuunel plot. Nine studies regarding the associations between the ADIPOQ 276G/T polymorphism and atherosclerosis risk were enrolled in this meta-analysis, including 1959 cases and 3739 controls. The 276G/T polymorphism was not significantly associated with atherosclerosis, yielding pooled ORs of 0.925 (95% CI: 0.728-1.178) and 0.921 (95% CI: 0.804-1.054), for TT versus GG, and TG versus GG, respectively. Significant between-study heterogeneity was not found in our meta-analysis. Furthermore there was no evidence of publication bias in the meta-analysis. The present meta-analysis showed that there is no association between ADIPOQ 276G/T polymorphism and atherosclerosis. High quality studies are still needed to add for more investigation of the association between ADIPOQ 276G/T polymorphisms and atherosclerosis
PMCID: PMC3897030  PMID: 24516495
Adiponectin; atherosclerosis; gene; meta-analysis; polymorphism
13.  Association of Nitrate, Nitrite, and Total Organic Carbon (TOC) in Drinking Water and Gastrointestinal Disease 
Objective. We aimed to investigate the amounts of nitrate, nitrite, and total organic carbon (TOC) in two drinking water sources and their relationship with some gastrointestinal diseases. Methods. This cross-sectional study was conducted in 2012 in Iran. Two wells located in residential areas were selected for sampling and measuring the TOC, nitrate (NO3−), and nitrite (NO2−). This water is used for drinking as well as for industrial and agricultural consumption. Nitrate and nitrite concentrations of water samples were analyzed using DR 5000 spectrophotometer. The information of patients was collected from the records of the main referral hospital of the region for gastrointestinal diseases. Results. In both areas under study, the mean water nitrate and nitrite concentrations were higher in July than in other months. The mean TOC concentrations in areas 1 and 2 were 2.29 ± 0.012 and 2.03 ± 0.309, respectively. Pollutant concentration and gastrointestinal disease did not show any significant relationship (P > 0.05). Conclusion. Although we did not document significant association of nitrite, nitrate, and TOC content of water with gastrointestinal diseases, it should be considered that such health hazards may develop over time, and the quality of water content should be controlled to prevent different diseases.
PMCID: PMC3649361  PMID: 23690803
14.  Skew-symmetric Random Effect Models with Application to a Preventive Cohort Study: Improving Outcomes in Low Back Pain Patients 
To investigate the respective contribution of various biologic and psychosocial factors, especially Health Related Quality of Life (HRQOL) as a main outcome, in the natural history of acute low back pain (LBP) and to evaluate the impact of this condition on HRQOL.
In a prospective cohort study For 24 weeks, 150 patients were assessed at an outpatient clinic in Korea consulting for low back and confirmed disc herniation duration at inclusion and treated with treatment package comprised of herbal medicines, acupuncture, bee venom acupuncture, and a Korean version of spinal manipulation (Chuna). Study participants were evaluated at baseline and every 4 weeks for 24 weeks. Low back intensity levels were measured on a visual analog scale (0-10), back function was evaluated with the Oswestry Disability Index (0-100), disability assessed by HRQOL assessed by the short form 36 health survey (0-100 in 8 different sub-categories).
Out of 150 patients, 128 completed the 24 weeks of traditional therapy. Patients reported improvements SF-36 outcome measures. At the completion of the study, low back pain scores improved by a mean of 3.3 (95% CI = 2.8 to 3.8). According to the results of our modeling, low back intensity level, back function and BMI measures had significant effects on quality of life during study. Interpreting the coefficients of modeling, the impact of the decreasing acute LBP episode on HRQOL by VAS and ODI outcomes, was high and important.
This study highlights the large contribution of integrative package therapy as an effective preventive method for improving LBP patient's HRQOL.
PMCID: PMC3634166  PMID: 23626884
Low back pain; health related quality of life; oswestry disability index
15.  Accuracy assessment of CKC high-density surface EMG decomposition in biceps femoris muscle 
Journal of neural engineering  2011;8(6):066002.
The aim of this study was to assess the accuracy of the Convolution Kernel Compensation (CKC) method in decomposing high-definition surface EMG (HDsEMG) signals from the pennate biceps femoris long-head muscle. Although the CKC method has already been thoroughly assessed in parallel-fibered muscles, there are several factors that could hinder its performance in pennate muscles. Namely, HDsEMG signals from pennate and parallel-fibered muscles differ considerably in terms of the number of detectable motor units (MUs) and the spatial distribution of the motor-unit action potentials (MUAPs). In this study, monopolar surface EMG signals were recorded from 5 normal subjects during low-force voluntary isometric contractions using a 92-channel electrode grid with 8 mm inter-electrode distances. Intramuscular EMG (iEMG) signals were recorded concurrently using monopolar needles. The HDsEMG and iEMG signals were independently decomposed into MUAP trains, and the iEMG results were verified using a rigorous a-posteriori statistical analysis. HDsEMG decomposition identified from 2 to 30 MUAP trains per contraction. 3±2 of these trains were also reliably detected by iEMG decomposition. The measured CKC decomposition accuracy of these common trains over a selected 10 second interval was 91.5±5.8 %. The other trains were not assessed. The significant factors that affected CKC decomposition accuracy were the number of HDsEMG channels that were free of technical artifact and the distinguishability of the MUAPs in the HDsEMG signal (P<0.05). These results show that the CKC method reliably identifies at least a subset of MUAP trains in HDsEMG signals from low force contractions in pennate muscles.
PMCID: PMC3422671  PMID: 21975280
Accuracy assessment; electromyography (EMG); EMG decomposition; high-density surface EMG; intramuscular EMG; motor unit; pennate muscles
16.  Noradrenalin Versus the Combination of Midodrine and Octreotide in Patients with Hepatorenal Syndrome: Randomized Clinical Trial 
Hepatorenal syndrome (HRS) is known as development of acute renal failure in a patient who usually has advanced liver disease. The aim of the present study was to determine the safety and the efficacy of noradrenalin in comparison with midodrine-octreotide in patients with HRS.
This study was registered to the Iranian Registry of Clinical trials (IRCT). This study was a single-center, randomized, clinical trial that performed in Alzahra hospital, Isfahan, Iran. Since March 2011 to January 2012, twenty-three patients were enrolled in the study. Eligible patients were allocated in 2 groups. In the first group, patients received infusion of NA with the dose of 0.1–0.7 μg/kg/min, and in the other groups, patients received octreotide 100-200 μg subcutaneously 3 times daily and midodrine 5-15 mg orally 3 times daily. In both study groups, patient received albumin infusion in addition to noradrenalin or midodrine-octreotide.
Complete response of HRS was observed in 8 of the 11 patients (73%) treated with noradrenalin and in 9 of the 12 patients (75%) treated with midodrine-octreotide (P > 0.05). HRS recurred after treatment withdrawal in 2 of 11 in NA and 3 of 12 in MO group. That shows no significant difference between 2 groups (P > 0.05).
We deduce that NA has the same efficacy and safety with MO and can induce a complete response in high percentage of the patients. Moreover, we observed no significant differences in the recurrence rate and outcomes after 3 months among the patients in both study groups; this result could support the use of NA in HRS management. The IRCT ID is: IRCT201107217085N1.
PMCID: PMC3506087  PMID: 23189227
Clinical trial; hepatorenal syndrome; midodrine; noradrenalin; octreotide
17.  First growth curves based on the World Health Organization reference in a Nationally-Representative Sample of Pediatric Population in the Middle East and North Africa (MENA): the CASPIAN-III study 
BMC Pediatrics  2012;12:149.
The World Health Organization (WHO) is in the process of establishing a new global database on the growth of school children and adolescents. Limited national data exist from Asian children, notably those living in the Middle East and North Africa (MENA). This study aimed to generate the growth chart of a nationally representative sample of Iranian children aged 10–19 years, and to explore how well these anthropometric data match with international growth references.
In this nationwide study, the anthropometric data were recorded from Iranian students, aged 10–19 years, who were selected by multistage random cluster sampling from urban and rural areas. Prior to the analysis, outliers were excluded from the features height-for-age and body mass index (BMI)-for-age using the NCHS/WHO cut-offs. The Box-Cox power exponential (BCPE) method was used to calculate height-for-age and BMI-for-age Z-scores for our study participants. Then, children with overweight, obesity, thinness, and severe thinness were identified using the BMI-for-age z-scores. Moreover, stunted children were detected using the height-for-age z-scores. The growth curve of the Iranian children was then generated from the z-scores, smoothed by cubic S-plines.
The study population comprised 5430 school students consisting of 2312 (44%) participants aged 10–14 years , and 3118 (58%) with 15–19 years of age. Eight percent of the participants had low BMI (thinness: 6% and severe thinness: 2%), 20% had high BMI (overweight: 14% and obesity: 6%), and 7% were stunted. The prevalence rates of low and high BMI were greater in boys than in girls (P < 0.001). The mean BMI-for-age, and the average height-for-age of Iranian children aged 10–19 years were lower than the WHO 2007 and United states Centers for Disease Control and Prevention 2000 (USCDC2000) references.
The current growth curves generated from a national dataset may be included for establishing WHO global database on children’s growth. Similar to most low-and middle income populations, Iranian children aged 10–19 years are facing a double burden of weight disorders, notably under- and over- nutrition, which should be considered in public health policy-making.
PMCID: PMC3471000  PMID: 22985219
Growth; Iran; Reference curve; Weight disorder
18.  Association of particulate air pollution and secondhand smoke on endothelium-dependent brachial artery dilation in healthy children 
This study aimed to determine the association of particulate matters with endothelial function, measured by flow mediated dilation (FMD) of brachial artery, in children with or without exposure to secondhand smoke.
This cross-sectional study was conducted from January to March 2011 in Isfahan, which is the second large and air-polluted city in Iran. The areas of the city with lowest and highest air pollution were determined, and in each area, 25 prepubescent boys with or without exposure to daily tobacco smoke in home were selected, i.e. 100 children were studied in total.
FMD was significantly smaller in those living in high-polluted area and those exposed to secondhand smoke. Multiple linear regression analysis, adjusted for age and body mass index, showed that both passive smoking status and living area in terms of particulate air pollution were effective determinants of the brachial artery diameter. The standardized coefficient of passive smoking status was –0.36 (SD = 0.09, P < 0.0001) showing negative association with percent increase in FMD. Likewise, the percent increase in brachial artery diameter was lower in passive smoker children. Similar relationship was documented for PM10 concentration with a regression coefficient of –0.32 (SD = 0.04, P < 0.0001). Without considering passive smoking variable, PM10 concentration has significant independent effect on FMD level.
Our findings provide evidence on the association of environmental factors on endothelial dysfunction from early life. Studying such associations among healthy children may help identify the underlying mechanisms. The clinical implications of environmental factors on early stages of atherosclerosis should be confirmed in longitudinal studies.
PMCID: PMC3526122  PMID: 23267390
Air pollution; children; endothelium-dependent brachial artery; smoke
19.  The Effects of Cardiac Tertiary Prevention Program after Coronary Artery Bypass Graft Surgery on Health and Quality of Life 
Cardiac tertiary prevention programs intend to support the recovery course following coronary artery bypass grafting (CABG). We investigated the effects of attendance at cardiac rehabilitation (CR) programs following CABG on patients’ mortality, morbidity and health related quality of life.
Eighty patients who underwent CABG were selected in a way that half of them had attended a cardiac rehabilitation program and the other half had not. Health related quality of life (HRQoL) was measured using the Short Form 36 (SF-36) questionnaire at a mean of 23.4 months postoperatively. Severity of cardiac symptoms on the basis of the New York Health Association (NYHA), the occurrence of any neurological symptoms, hospitalization and restoration of patients to their previous level of performance in social activities were assessed after CABG surgery.
There were no deaths. There were no differences in postoperative NYHA scores, neurological symptoms, and hospitalization. Three of the eight health domains measured by SF-36, namely general health (P = 0.010), physical function (P = 0.002), and mental health (P < 0.001), showed significantly better values for attendants than non-attendants. Rehabilitation participants returned to their previous level of performance in social activities more than their control counterparts.
Higher general health scores (SF-36) were associated with attendance at CR programs. The findings of this study provide rationale to consider a broader scope of physiological and psychosocial parameters to predict outcomes of CABG surgery.
PMCID: PMC3237271  PMID: 22174968
Coronary artery bypass grafting; Cardiac rehabilitation; Health related quality of life
20.  Using skew-symmetric mixed models for investigating the effect of different diabetic macular edema treatments by analyzing central macular thickness and visual acuity responses 
Diabetic Macular Edema (DME) is one of the major causes of visual loss and increase in central macular thickness (CMT). The aim of this study was to determine the efficacy of a single intravitreal injection of bevacizumab (IVB) alone or in combination with intravitreal triamcinolone acetonide (IVB/IVT) versus macular laser photocoagulation (MPC) as primary treatment for DME when confounders were considered.
Skew-symmetric bivariate mixed modeling according to best corrected visual acuity (BCVA) and CMT was done on the data of 103 diabetic patients from ophthalmic research center of Labbafinejad medical center (Tehran, Iran) to determine the best DME treatment by adjusting the effect of confounders.
Although there was no significant difference between IVB/IVT (p > 0.05), these two treatments increased BCVA and decreased CMT better than MPC (p < 0.05). The following three groups showed better treatment responses: 1) women, 2) patients with more diabetes duration, 3) patients whose CMT were higher and VA were lower at the beginning of the clinical trial.
Using skew-symmetric mixed effect model as updated statistical method in presence of asymmetric or outlier data, we received different results compared to the same investigation on this study by analyzing BCVA and CMT simultaneously. This research demonstrated the effect of IVB alone or in combination with intravitreal IVB/IVT on visual power and decreasing CMT during follow up.
PMCID: PMC3430022  PMID: 22973326
Best-Corrected Visual Acuity; Central Macular Thickness; Diabetic Macular Edema; Skew-symmetric Mixed Models

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