Incidence of metabolic syndrome and determinants of its progression in Southern Iran: A 5-year longitudinal follow-up study

Background

Metabolic syndrome (MetS) is a cluster of conditions increasing the risk of serious diseases. This study aimed to define the predictors of MetS incident in a community-based cohort in Southern Iran, during a mean follow-up period of 5.1 years.

Materials and Methods

During the mean follow-up period of 5.1 years, a cohort study was conducted on 819 Iranian adults aged ≥18 years at baseline and followed to determine the incidence and predictors of MetS progression in Shiraz, a main urban region in the southern part of Iran. The International Diabetes Federation Guideline was used to detect the MetS. Multiple Cox's proportional hazards models were also used to estimate the predictors of new-onset MetS.

Results

The prevalence of MetS was 25.9% at baseline, and the overall incidence of subsequent MetS was 5.45% (95% confidence interval [CI]: 4.47-6.59). The incidence of MetS was significantly higher in women (7.12% [95% CI: 5.52-9.05]) than in men (3.92% [95% CI: 2.80-5.34]). Moreover, it increased by 5.02 (95% CI, 3.75-6.58) among individuals who had one metabolic component and by 12.65 (95% CI, 9.72-16.18) for those who had three or more components (P < 0001). The incidence of MetS was also analyzed using the multiple Cox's proportional hazards model for potential risk factors, and it was revealed that female gender (hazard ratio [HR] 2.45; 95% CI: 1.33, 4.50; P = 0.004), higher body mass index (HR 3.13; 95% CI: 1.43.6.84; P = 0.012), increased abdominal obesity (HR 1.45; 95% CI 0.85, 2.46; P = 0.045), smoking (HR 4.79; 95% CI 2.09, 10.97; P < 0.001), and lower high-density lipoprotein (HR 0.53; 95% CI: 0.29, 1.00; P = 0.044) significantly predicted the onset of MetS at baseline; however, age, systolic and diastolic blood pressure, serum uric acid, fasting blood glucose, cholesterol, triglyceride and creatinine, estimated glomerular filtration rate, marital status, level of education, and level of physical activity did not independently predict the onset of MetS when other covariates were considered.

Conclusion

This study showed the high-incidence rates of MetS in males and females residing in Southern Iran. Therefore, the prevention through community-based lifestyle modification should be implemented to reduce the burden of MetS and its complications.

A Population-Based Study on the Prevalence and Risk Factors of Chronic Kidney Disease in the Adult Population of Shiraz, Southern Iran

Background:

Currently, we are facing a significant increase in the new cases of the end-stage renal disease in developing countries. Hence, it seems vital to work on strategies aimed at reducing its development and progression. Determining the related risk factors can provide an insight into achieving these policymaking goals. Therefore, this study was conducted to identify risk factors associated with chronic kidney disease (CKD) in the Iranian adult population.

Materials and Methods:

This cross-sectional study was performed in Shiraz, Southern Iran, through a cluster random sampling technique that involved 819 subjects, including 340 male and 479 female adult participants. Factors such as the body mass index, waist circumference, blood pressure, and biochemical profile were determined. We evaluated the prevalence of CKD according to the glomerular filtration rate (GFR), as well as possible risk factors associated with it. GFR was calculated on the basis of the "Chronic Kidney Disease Epidemiology Collaboration" creatinine equation.

Results:

The cluster comprised 58.5% females and 41.5% males. The mean age of our participants was 43.0 ± 14.0 years. Our results showed that 16.6% of adult urban inhabitants in Iran had CKD (stages 3 to 5, eGFR ≤60), that is, GFR less than 60 mL/min/1.73 m2. The proportion of participants having hypertension, obesity, high waist circumference, diabetes mellitus, and history of cardiovascular disease was 17.3%, 19.3%, 35%, 9.4%, and 5.3%, respectively. Multiple regression analysis indicated an independent correlation between age, sex, dyslipidemia, and hypertension with CKD.

Conclusion:

This study indicates that CKD is a substantial health burden in Iranian adult population. Additionally, the results of this study addressed the importance of integrated strategies that aimed to identify, prevent, and treat noncommunicable diseases fueling the development of CKD.

Assessment of Otolaryngology Residency Training Program in Iran: Perspectives of Faculty Members and Recently Graduated Medical Students

INTRODUCTION

There is limited evidence regarding the quality of otolaryngology residency programs in Iran. Regarding this, the present study aimed to assess some aspects of otolaryngology residency program in the field of otology in Iran based on the perspectives of faculty members and graduates.

MATERIALS AND METHODS

This study was conducted on 105 recent graduates and 30 faculty members and/or program directors in otolaryngology using two self-administered questionnaires.

RESULTS

While the faculty members believed that a resident should work on at least 5.4 temporal bone surgeries on average, the actual number was 2.49. Tympanoplasty was assigned the highest rate of satisfaction by the recent graduates, whereas the lowest score belonged to middle ear exploration, ossiculoplasty, and stapes surgery. Only 53.6% of the graduates stated that there was an organized training curriculum in temporal laboratory. The recent graduates reported to have more frequent experiences of performing usual otology operations. However, they had fewer experiences of performing more advanced surgeries. The recently graduated subjects had a significantly low level of satisfaction with their competencies in carrying out more complex types of otology surgeries.

CONCLUSION

High prevalence of otology surgeries in Iran provides valuable opportunities for training otolaryngology residents to achieve an acceptable level of competency. However, the results of this study strongly suggest the necessity of quality improvement both in teaching-learning and assessment processes in otolaryngology training programs.

Non alcoholic fatty liver disease in southern Iran: a population based study

BACKGROUND

Population based studies on prevalence and risk factors of NAFLD in Iranian population are few. The prevalence of NAFLD and non alcoholic steatohepatitis (NASH) in Iranians varies from 2.9% to 7.1% in general population and 55.8% in patients with type 2 diabetes mellitus.

OBJECTIVES

To determine the prevalence and determinants of non alcoholic fatty liver disease (NAFLD) in a sample of adult Iranian general population.

PATIENTS AND METHODS

This was a cross-sectional study being performed in Shiraz, southern Iran during a 10-month period from November 2010 to September 2011 through cluster random sampling of Iranian general population in Shiraz region. All individuals undergone anthropometric, blood pressure measurements, thorough medical history and physical examinations. Laboratory measurements included fasting blood glucose (FBS), lipid profile, complete blood count (CBC) and liver function tests. NAFLD was diagnosed by transabdominal ultrasonography.

RESULTS

819 subjects were included in this study among which were 340 males (41.5%) and 479 females (58.5%) with the mean age of 43.1 ± 14.1 years. NAFLD was diagnosed in 176 (21.5%) subjects. Patients with NAFLD were significantly older (P < 0.001), had higher proportion of male gender (P = 0.004) and had higher BMI (P < 0.001). They also had higher prevalence of hypertension (P < 0.001), high FBS (P < 0.001), high cholesterol (P = 0.026), high triglyceride (P < 0.001) and high waist circumference (P < 0.001). Taking all these together, patients with NAFLD had significantly higher prevalence of metabolic syndrome when compared to healthy subjects (P < 0.001).

CONCLUSION

The prevalence of NAFLD in this group of Iranian adult general population is 21.5%. NAFLD in Iranian population is associated with male gender, old age, obesity, and features of metabolic syndrome.

Reducing Social Disparity in Liver Transplantation Utilization through Governmental Financial Support

BACKGROUND

A high proportion of patients suffering from end stage liver disease are from low socioeconomic classes , which limits their access to liver transplantation as the most effctive treatment of this condition because of cost barrier.

OBJECTIVES

one of the most challenging aspects of liver transplantation is its affordability and utilization by those who need it the most.

PATIENTS AND METHODS

Since November 2005, Iran Ministry of Health had covered 100% of the costs of in-patient liver transplantation care. To determine the effects of this policy, patterns of utilization of liver transplantation were compared before and after implementation of the policy. Group one included 112 and group two included 120 individuals who received transplantation before (from early January 2003 to November 2005) and after (from November 2005 to the end of December 2007) the legislation entered into the effect, respectively. Socioeconomic characteristics of these patients were evaluated by data collected about house and car ownership, education level, employment status, and place of residence.

RESULTS

Coverage of the costs allowed more illiterate and semiliterate people (P = 0.032) as well as more unemployed or unskilled workers to receive transplantation (P = 0.021). The number of transplantations also increased in children and geriatric age group. This legislation also led to greater countrywide regional coverage of indigent patients.

CONCLUSIONS

This survey provides evidence that coverage of the costs by Ministry of Health was effective in reducing social discrimination in utilization of liver transplantation, and narrowed the gap between low and high socioeconomic classes in Iranian society.

Serum level of matrix metalloproteinase-3 in patients with oral lichen planus

BACKGROUND

Oral Lichen planus (OLP) is a chronic lesion of the oral mucosa with unknown origin. Basement membrane changes are common in OLP and may be mediated by proteases such as matrix metalloproteinase (MMPs) and mast cell chymase. The aim of our study was to evaluate the level of serum MMP-3 in OLP com-pared to normal individuals and assess its clinical significance.

METHODS

Thirty four serum samples from patients diagnosed with OLP (12 males, 22 females, age: 42.2±10.8 years) and 34 serum samples from healthy control subjects (11 males, 23 females, age: 42.5±13.3 years) were collected and MMP-3 concentration was measured by ELISA.

RESULTS

The serum MMP-3 level in OLP patients was higher (21.64±24.31 ng/ml) compared with healthy con-trols (16.52±23.63 ng/ml), but showed no statistically significant difference. A statistically significant difference was demonstrated between the two types of OLP, being more pronounced in the erosive/atrophic form 6).

CONCLUSION

The different clinical appearances of OLP are associated with significant differences in MMP-3 serum level.

Prevalence of breast cancer in a defined population of iran

Background

Prevalence of breast cancer in Asian developing countries is much lower than western developed countries. The main aim of this study was to measure breast cancer prevalence in a defined population of Iran.

Methods

A total of 25201 women who were under coverage of “Imam Khomeini Relief Foundation (IKRF)”, which is an organization for delivering supportive social and cultural services to the deprived and poor subgroups of the society, were involved in the study. The study was conducted during years 2007 and 2008. All subjects were interviewed for their socio-demographic features and underwent precise clinical and para-clinical breast examination.

Results

Mean age was 47 years with standard deviation 10 ranging from 11 to 88 years. Subjects were from deprived subgroups of the community; were mainly illiterate or had primary school education (86%) and majority of them (93%) had their first full-term pregnancy at age less than 26 years and also were multiparous. With confirmed diagnosis by breast biopsy, breast cancer prevalence was 0.15% (95%CI; 0.10-0.20).

Conclusion

Compared with developed countries, Asian developing countries have been at a lower risk of breast cancer development. It is seen that more deprived subgroups are at much lower risk. The more industrialized life is accompanied with more hazards.

Comparison of oral and intravenous proton pump inhibitor on patients with high risk bleeding peptic ulcers: a prospective, randomized, controlled clinical trial

BACKGROUND

Proton pump inhibitors (PPIs) decrease the rate of rebleeding following endoscopic hemostatic therapy in patients with bleeding peptic ulcers. This study compares the efficacy of oral omeprazole vs intravenous pantoprazole in decrease of rebleeding of peptic ulcer patients.

METHODS

One hundred and six patients with high risk peptic ulcer were randomized to receive either oral omeprazole (80 mg BID for 3 days) or IV pantoprazole (80 mg bolus and 8 mg/hour infusion for 3 days) followed by omeprazole (20 mg each day for 30 days). All patients underwent upper endoscopy and endoscopic therapy within 24 hours.

RESULTS

Seventeen patients were excluded from the study. Forty four patients were randomly allocated into omeprazole group and 41 patients to IV pantoprazole group. Both groups were similar for factors affecting the outcome. Bleeding reoccurred in five patients of omeprazole group and four patients in pantoprazole group (11.4% vs 9.8 %). The mean hospital stay and blood transfusion were not different in both groups.

CONCLUSION

Oral omeprazole and IV pantoprazole had equal effects on prevention of rebleeding after endoscopic therapy in patients with high risk bleeding peptic ulcers.

Assessment of the consensus about tonsillectomy and/or adenoidectomy among pediatricians and otolaryngologists

BACKGROUND

Several recent publications have shown that the current indications for tonsillectomy and/or adenoidectomy (T&A) in children vary considerably between and even within countries. The objective of our study is to present statistically valid information to surgeons and pediatricians, primary care physicians, and family physicians as key referral channels to the operation, whether there is consensus between pediatricians and otolaryngologists regarding the appropriateness of T&A.

METHODS

Six academic pediatricians and six otolaryngologists participated in the study. After otolaryngologists visited 200 patients, the cases were referred to a pediatrician who also visited the patients independently on the same day pre-operatively. They ranked the appropriateness of T&A on a numerical Likert scale from 0 (never indicated) to 9 (always indicated) in a questionnaire.

RESULTS

Overall, 200 (102 boys and 98 girls) children with a mean age of 6.1+/-5.6 were enrolled in this study. Otolaryngologists and Pediatricians had agreed about the history of tonsillitis attacks in the previous 6 months and previous year. The patients provided them with the same history. The agreement between otolaryngologists and pediatrician's views about T&A was poor.

CONCLUSIONS

This study can serve as an initial warning in developing a national community-based working group to prepare a transparent local guideline regarding T&A indications. More attention should focused the role of pediatricians, primary care physicians, and family physicians for more follow up and determining which patients will eventually need T&A.

Prevalence of dyspepsia and its correlation with demographic factors and lifestyle in shiraz, southern iran

BACKGROUND Dyspepsia is a common disorder that can present many clinical dilemmas in patient management. Although not life-threatening, the symptoms are long-lasting, interfere with daily activities and have a significant impact upon quality of life. The aim of this study was to determine prevalence of dyspepsia and its relationship with demographic and socioeconomic factors, and lifestyle in an apparently healthy population in Shiraz, southern Iran. METHODS In a population-based study, 1978 subjects aged 35 years or older were interviewed from April to September 2004. A questionnaire consisting of demographic factors, lifestyle data and gastrointestinal symptoms was completed for each participant. The validity and reliability of the questionnaire were determined. RESULTS The prevalence of dyspepsia was 29.9%. The dyspeptic patients were classified as having ulcer-like (27.9%), dysmotility-like (26.2%) or unspecified dyspepsia (45.9%). The prevalence was higher in females, water-pipe smokers, NSAIDs users, and in those with psychological distress, recurrent headache, anxiety, nightmares and past history of gastrointestinal disease. Dyspepsia had an inverse relationship with consumption of pickles, fruits and vegetables, and with duration of meal ingestion. Subjects with dyspepsia symptoms were more likely to restrict their diet, take herbal medicine, use over-the-counter drugs, consult with physicians and consume medication advised by their friends. CONCLUSION This study reveals that dyspepsia has a high prevalence in Shiraz, southern Iran and is associated with several demographic factors, lifestyle and health-seeking behavior.

Is Carhart notch an accurate predictor of otitis media with effusion?

BACKGROUND

In the era of pediatric otolaryngology, a number of different methods have been used for the diagnosis of otitis media with effusion (OME). Although there are divers articles within the filed of assessment of the accuracy of diagnostic methods of OME, surprisingly there are very few data published and a small number of researches explaining the accuracy of Carhart notch (CN) for diagnosis of OME cases and comparing the CN with abnormal tympanic membrane findings in binocular microtympanoscopy.

METHODS

Audiometric parameters studied in 89 children (178 ears) suffering from chronic otitis media with effusion. Significant CN was defined as a minimum depression of 10 dB in comparison of the rest of thresholds, at any frequency from 500 to 4000 Hz. Intra-operative microscopic otoscopic findings and the type of middle ear fluid were documented in a specially formatted questionnaire.

RESULTS

The incidence of CN was 44.94% (80 ears) and that of significant CN was 25.28% (45 ears). The correlation between abnormal tympanic membrane findings and significant CN was significant and the association between CN and middle ear effusion (MEE) was not statistically significant.

CONCLUSIONS

Significant CN is a sensitive diagnostic tool for detection of MEE but not specific. The diagnosis of OME in children requires a combinational diagnostic methods including tympanometry and audiometric variables especially CN.

Histopathological screening of tonsillectomy and/or adenoidectomy specimens: a report from southern Iran

BACKGROUND

The need for pathologic examination of all tonsillectomy and/or adenoidectomy (T&A) specimens is controversial. Microscopic pathologic examination of these specimens is costly, but neglecting this step may miss diagnoses of significant diseases, especially malignancies. This study was designed to determine the rate of unexpected malignancies among patients who underwent T&A.

METHODS

All patients who underwent T&A at Shiraz University of Medical Sciences between February 2004 and February 2008 were included in a prospective study. Gross and microscopic pathologic examinations were done on all the specimens. The charts of the patients with significant pathological finding were reviewed. Information about pre-operative signs, symptoms, and risk factors were used to verify unexpected pathologic findings.

RESULTS

A total of 5058 patients were included. The age distribution was 10 months to 92 years (mean 14.0 years). There were 2498 males (49.4) and 2560 females (50.6%). Significant pathological findings were detected in 54 patients (1%). One unexpected malignancy (0.019%) was found in an adult patient. No unexpected malignancies were found in pediatric patients.

CONCLUSIONS

All T&A specimens in the adult population should be sent for microscopic pathological examination. Also specimens of nonroutine T&A in children (with positive findings in the medical history or on physical examination) should be sent for microscopic pathological examination. In children without positive findings in their history or on physical examination, gross pathological evaluation of routine T&A specimens by a pathologist is sufficient.

Growth of infants in relation to type of feeding in Jahrom, Islamic Republic of Iran

We evaluated the growth of 597 infants < 24 months attending health centres in Jahrom according to type of infant feeding. We also compared our growth curves with those of the National Center for Health Statistics (NCHS). The infants were divided to 3 groups: exclusively breastfed, exclusively bottle-fed and both breast- and bottle-fed and were assessed monthly for the first year and every 2 months in the second year. There were no significant differences between the groups in height and weight in the first few months of birth; later, breastfed infants were significantly heavier and taller. The mean heights and weights of our infants were lower that those for NCHS.

Epidemiology of depression among infertile and fertile couples in Shiraz, southern Iran

BACKGROUND

Depression is considered as one of the main psychological disorders associated with infertility. Depression may play a significant role in the life of infertile individuals, their infertility treatment follow-up and in their hopefulness for the future; it may also influence the intensity and continuousness of the mutual relationship of the affected couple.

AIMS

This study was done to determine the depression rate and make a comparison between infertile and fertile couples with respect to the same.

SETTING AND DESIGN

The depression rate was evaluated between two groups--infertile couples (case group) and fertile couples (control group).

MATERIALS AND METHODS

Ninety-one infertile couples (cases) and 9l fertile ones (controls) were randomly enrolled in our study. Beck depression inventory (BDI) and demographic information were provided.

STATISTICAL ANALYSIS

We used Chi-square, t-test; and one-way Analysis of Variance (ANOVA) was performed to find out significant difference between infertility duration in various couples and its effect on the score of depression.

RESULTS

The BDI mean difference between infertile and fertile couples was significant (P=0.015). It was significantly more among couples with infertility from 1-3 years' duration compared to those with infertility of 1-year duration or less.

CONCLUSION

Regarding the high rate of depression among infertile couples, it seems necessary to pay more attention to infertility centers that offer psychological and psychiatric services.