Environmental Surveillance of Poliovirus and Non-polio Enteroviruses in Iran, 2017-2023: First Report of Imported Wild Poliovirus Type 1 Since 2000

In Iran, which is at high risk of the Wild Poliovirus (WPV) and Vaccine-Derived Poliovirus (VDPV) importation due to its neighborhood with two polio endemic countries, Pakistan and Afghanistan, Environmental Surveillance (ES) was established in November 2017. Sistan-Balouchestan province was chosen for the ES due to its vicinity with Pakistan and Afghanistan. Five sewage collection sites in 4 cities (Zahedan, Zabol, Chabahar and Konarak) were selected in the high-risk areas. Since the establishment of ES in November 2017 till the end of 2023, 364 sewage specimens were collected and analyzed. The ES detected polioviruses which have the highest significance for polio eradication program, that is, Wild Poliovirus type 1 (WPV1) and Poliovirus type 2 (PV2). In April and May 2019, three of 364 (0.8%) sewage specimens from Konarak were positive for imported WPV1. According to phylogenetic analysis, they were highly related to WPV1 circulating in Karachi (Sindh province) in Pakistan. PV2 was also detected in 5.7% (21/364) of the sewage specimens, most of which proved to be imported from the neighboring countries. Of 21 isolated PV2s, 7 were VDPV2, of which 5 proved to be imported from the neighboring countries as there was VDPV2 circulating in Pakistan at the time of sampling, and 2 were ambiguous VDPVs (aVDPV) with unknown source. According to the findings of this study, as long as WPV1 and VDPV2 outbreaks are detected in Iran's neighboring countries, there is a definite need for continuation and expansion of the environmental surveillance.

Deep Learning-Based Classification of Subtypes of Primary Angle-Closure Disease With Anterior Segment Optical Coherence Tomography

PRCIS

We developed a deep learning-based classifier that can discriminate primary angle closure suspects (PACS), primary angle closure (PAC)/primary angle closure glaucoma (PACG), and also control eyes with open angle with acceptable accuracy.

PURPOSE

To develop a deep learning-based classifier for differentiating subtypes of primary angle closure disease, including PACS and PAC/PACG, and also normal control eyes.

MATERIALS AND METHODS

Anterior segment optical coherence tomography images were used for analysis with 5 different networks including MnasNet, MobileNet, ResNet18, ResNet50, and EfficientNet. The data set was split with randomization performed at the patient level into a training plus validation set (85%), and a test data set (15%). Then 4-fold cross-validation was used to train the model. In each mentioned architecture, the networks were trained with original and cropped images. Also, the analyses were carried out for single images and images grouped on the patient level (case-based). Then majority voting was applied to the determination of the final prediction.

RESULTS

A total of 1616 images of normal eyes (87 eyes), 1055 images of PACS (66 eyes), and 1076 images of PAC/PACG (66 eyes) eyes were included in the analysis. The mean ± SD age was 51.76 ± 15.15 years and 48.3% were males. MobileNet had the best performance in the model, in which both original and cropped images were used. The accuracy of MobileNet for detecting normal, PACS, and PAC/PACG eyes was 0.99 ± 0.00, 0.77 ± 0.02, and 0.77 ± 0.03, respectively. By running MobileNet in a case-based classification approach, the accuracy improved and reached 0.95 ± 0.03, 0.83 ± 0.06, and 0.81 ± 0.05, respectively. For detecting the open angle, PACS, and PAC/PACG, the MobileNet classifier achieved an area under the curve of 1, 0.906, and 0.872, respectively, on the test data set.

CONCLUSION

The MobileNet-based classifier can detect normal, PACS, and PAC/PACG eyes with acceptable accuracy based on anterior segment optical coherence tomography images.

One-year outcomes of combined phacoemulsification and viscogoniosynechialysis with and without endoscopic cyclophotocoagulation in primary angle-closure glaucoma

PURPOSE

To compare the outcomes of combined phacoemulsification and viscogoniosynechialysis (VGSL) with and without endoscopic cyclophtocoagulation (ECP) in primary angle-closure glaucoma (PACG).

METHODS

In this prospective interventional case series 52 eyes of 50 patients were enrolled. Twenty-seven eyes underwent combined phacoemulsification and VGSL (PV group) and 25 eyes underwent the same procedure plus circumferential ECP (PVE group). All eyes were followed 1 day, 1 week, 3 months, 6 months, and 1 year after the procedure. Intraocular pressure and antiglaucoma medications were compared between and within groups using generalized estimating equations. Kaplan-Meier survival analysis was carried out to compare intensity to failure between groups.

RESULTS

The mean ± SD age was 63.23 ± 6.87 years and 50% of the cases were male in the entire group. Intraocular pressure (IOP) and antiglaucoma medications were significantly reduced at all time points in comparison with the baseline in both groups (p < 0.05). There was no significant difference between groups in either IOP or medications at specific time points (p > 0.05). One eye in each group developed a fibrinous reaction in the postoperative period. There was no statistically significant difference between groups regarding the intensity to failure (P = 0.169).

CONCLUSION

There were no significant differences in IOP and medication reduction between groups. Also, the complications were comparable between groups.

The national health program for vitamin D supplementation in a developing country

BACKGROUND

Previous studies have reported a high frequency of vitamin D deficiency (VDD) among different age groups in Iran.

AIMS

In this study, the current coverage, status of vitamin D supplement taking, and program efficacy have been evaluated by the Office of Nutrition Department Society in Iran since 2014.

METHODS

This study was conducted in collaboration with the International UNESCO center for Health-Related Basic Sciences and Human Nutrition and the Office of Nutrition Department Society. Sixty three medical universities were included in the current study to calculate the availability, accessibility and acceptability coverages. Furthermore, 3 medical universities including Mashhad (MUMS), Qom (QUMS) and Zahedan (ZAUMS) University of Medical Sciences were selected based on the results of the National Integrated Micronutrient Survey 2012 (NIMS-II study), in order to assess the status of vitamin D supplement intake in all age ranges.

RESULTS

Quantitative analysis showed that availability coverage was 74.96% and 77.56% and accessibility was 80.70% and 83.26% in elderly and middle-aged subjects, respectively in 2018. The acceptability was approximately 43.7% and 43.9% among elderly and middle-aged participants, respectively. The availability and acceptability coverage was 80.99% and 85.0% among students in high schools. The mean vitamin D supplement uptake frequency was 27.0% (n = 387); 20.7% and 29.2% in rural and urban area, respectively (P = 0.001). The results showed that there was no significant difference in serum vitamin D levels between urban (20.41 ± 6.43 ng/ml) and rural areas, (P = 0.887). There was no significant difference in the serum vitamin D concentrations between men and women (P = 0.461).

CONCLUSIONS

The frequency of taking vitamin D supplements was 27.0% in Iran in 2018. The frequency of taking of vitamin D supplements among vitamin D deficient group (serum vitamin D levels <19.99 ng/ml) was 43.6%. Lack of knowledge was the most important reason for not taking vitamin D supplement. Moreover, the serum vitamin D levels have increased in subjects aged 18-30 years old after the implementation of the vitamin D supplementary program.

Plateau Iris: A Review

Purpose

To review the concept of plateau iris and summarize the recent evidence on its diagnosis and management.

Methods

This is a narrative review on the plateau iris. A literature review was conducted in PubMed, Google Scholar, and Scopus databases using keywords: angle-closure glaucoma, glaucoma, nonpupillary block glaucoma, plateau iris, and plateau iris management.

Results

This review defined the current knowledge about plateau iris. First of all, the anatomy and epidemiology were discussed. Then, we outlined the available evidence on the diagnosis of plateau iris and its differential diagnosis. Conclusively, the treatment options were mentioned.

Conclusions

Plateau iris is a condition in which nonpupillary block mechanisms are responsible for intraocular pressure elevation and angle closure attack when a patent peripheral iridotomy has removed the relative pupillary block. An anteriorly positioned ciliary body causes mechanical obstruction of trabecular meshwork in these patients. It is usually seen in younger patients with angle closure and is diagnosed by gonioscopic examination and imaging modalities such as Ultrasound biomicroscopy. Despite the known mechanism of plateau iris, there is no consensus over treatment. Low-dose pilocarpine and Argon laser peripheral iridoplasty are nonsurgical treatments for these patients, but their effects are short-term. Cataract extraction with/without endocyclophotocoagulation (ECP), endocycloplasty, excisional goniotomy, and transscleral cyclophotocoagulation are alternative treatments. Patients should be examined periodically for further progression or recurrence of plateau iris. In cases of glaucoma unresponsive to conventional medical treatments, surgical treatments such as trabeculectomy and drainage devices should be considered.

Management of Malignant Glaucoma

Purpose

To compare the outcomes of various invasive and noninvasive approaches to the treatment of malignant glaucoma.

Methods

Glaucoma-related keywords were looked up in PubMed and Google Scholar, and related articles up to 2022 were used to put together this review article.

Results

Numerous surgical methods and techniques have been introduced in the past few years. This review outlined current knowledge regarding the nonsurgical and surgical management of malignant glaucoma. In this regard, we first briefly outlined the clinical presentation, pathophysiology, and diagnosis of this disorder. Then, the current evidence on the management of malignant glaucoma was reviewed. Finally, we discuss the need for treatment of the other eye and the factors that might affect the outcome of surgical intervention.

Conclusions

Fluid misdirection syndrome, or malignant glaucoma, is a severe disorder that can occur spontaneously due to surgical intervention. The pathophysiology of malignant glaucoma is complicated, and numerous theories exist about the underlying mechanisms that may contribute to the disease. Malignant glaucoma can be treated conservatively using medications, laser therapy, or surgery. Laser treatments and medical treatments have been adequate for the treatment of glaucoma, but the effects have generally been short-lived, and surgical treatment has proved to be the most effective. There have been a variety of surgical methods and techniques introduced. Still, none have been studied in a large proportion of patients as a control case to compare effectiveness, outcomes, and recurrence. Pars plana vitrectomy with irido-zonulo-capsulectomy still seems to have the best results.

The thickness of the outer retina in the macula and circumpapillary area in patients with unilateral advanced glaucoma

PURPOSE

To compare outer macular and retinal thickness in the circumpapillary area in unilateral advanced glaucomatous eyes to the normal or mild glaucomatous fellow eyes.

METHODS

Seventy-eight eyes of 39 patients with unilateral advanced glaucoma (mean deviation (MD) worse than -12.00 dB based on visual field 24-2) were included in this cross-sectional study as the cases. The healthy or mild glaucomatous fellow eyes were enrolled as the control group. All eyes underwent optical coherence tomography of the macula and circumpapillary retina by Topcon DRI Triton (Topcon, Tokyo, Japan). Ganglion cell layer 2+ was considered as the inner retina. Total retinal thickness minus the thickness of the inner retina was considered as the outer retina. Comparison between groups was done by paired-sample sign test. The correlation between structural and functional parameters was evaluated by a partial correlation coefficient.

RESULTS

Seventeen (43.6%), 15 (38.5%), and 7 (17.9%) patients had pseudoexfoliation, primary angle-closure, and primary open-angle glaucoma, respectively. The mean age was 62.69 ± 12.00 years. Thirty-three (84.6%) patients were male. The outer retinal thickness in the circumpapillary area was higher in temporal, superior, and inferior quadrants (p < 0.05). The outer macula in different parafoveal and perifoveal quadrants was also thicker (p < 0.05). Average outer parafoveal thickness in the case group had a significant negative correlation with MD (r = -0.339; p = 0.035).

CONCLUSION

Advanced glaucomatous eyes had a thicker outer retina in the macula and circumpapillary area. There was a significant negative correlation between outer perifoveal thickness and MD.

Six-month outcomes of combined conventional needle goniotomy and phacoemulsification in eyes with early to moderate primary open-angle and pseudoexfoliation glaucoma and ocular hypertension

Purpose:

Angle-based surgeries for the treatment of open-angle glaucoma have gained popularity in recent years. This study aimed to evaluate the efficacy of combined phacoemulsification and goniotomy in primary open-angle and pseudoexfoliation glaucoma (POAG and PXG) and ocular hypertension (OHTN).

Methods:

In this interventional case series in the setting of the Glaucoma Service at the Farabi Eye Hospital, 32 eyes of 30 patients with early-to-moderate POAG and PXG and OHTN were enrolled. All eyes underwent combined phacoemulsification and needle goniotomy. Intraocular pressure (IOP) and the number of antiglaucoma medications as well as demographic data were recorded at baseline and one day, one week, one month, three months, and six months after the surgery. Generalized Estimating Equation (GEE) was used to compare the values of IOP and the number of medications at different time points. Kaplan–Meier graph was used to demonstrate the survival status of the eyes.

Results:

Mean IOP at baseline was 21.8 ± 4.6 mmHg on mean 1.2 ± 1.5 topical medications. There was a 25.2% (16.3 ± 4.5 mmHg) and 32.1% (14.8 ± 3.9 mmHg) reduction in IOP at three and six months after procedure, respectively (P < 0.001). Meanwhile, the decline in medications was 66.7% (0.4 ± 0.9) and 50.0% (0.6 ± 1.1) at the same time points (P = 0.002 and P = 0.048, respectively). Post-operative complications were clot hyphema (n = 1, 3.1%), fibrinous inflammation (n = 1, 3.1%) and distorted pupil (n = 2, 6.3%).

Conclusion:

Combined phacoemulsification and needle goniotomy as a procedure for mild and moderate POAG and PXG and OHTN is as effective as other modified goniotomies in the setting of minimally invasive glaucoma surgeries (MIGS).

Is nutritional functional diversity in the rural food and nutrition system associated with food security and nutrient adequacy? A case study of rural areas of Zahedan district, Iran

BACKGROUND

An overlooked problem in food and nutrition system analysis is assuring adequate diversity for a healthy diet. Little is known about nutrient diversity in food and nutrition systems and how it transmits to dietary diversity. Nutritional functional diversity (NFD) is a metric that describes diversity in providing nutrients from farm to market and the consumption level. The objective of this study is to determine the NFD score at different stages of the rural food and nutrition system, including household's agricultural and home production, domestic food processing, purchased food, and diet. It also aims to explore the association between NFD and nutrient adequacy, food security, and anthropometric indicators.

METHODS

A cross-sectional study was conducted on 321 households in 6 villages of Zahedan district. The NFD score was measured at three subsystems (production, processing, and consumption) of the food and nutrition system. Household food security, mean adequacy ratio (MAR), and anthropometrics of the household's head were measured to assess the association between NFD and food and nutrition indicators. Linear and bivariate statistical techniques were applied to study the associations between variables.

RESULTS

In the rural food and nutrition system, the food purchased from the city plays the main role in the households NFD score. Their contribution to total NFD was twice that of the food items purchased from the village. The NFD score of homestead production and households food processing was found to be five times less than those of food purchased from cities. The food insecure households had significantly lower NFD scores for food purchased from the city and higher NFD scores for purchased food items from the rural market and native wild vegetable consumption. A strong and positive relationship was observed between NFD of food items purchased from the city and households'MAR. No significant association was found between the NFD score of homestead production, processing, and dependent variables, i.e. food insecurity, MAR, and household head anthropometrics.

CONCLUSION

NFD score, as a relatively new metric, could help in determining diversity from farm to diet and identifying the gaps to plan appropriate interventions for improving diversity in the local food system.

Epidemiological and clinical risk factors related to severe COVID-19 in Iran: a multi-center study

Background

Iran was one of the first countries to be affected by COVID-19. Identifying factors associated with the severity of COVID-19 is effective in disease management. This study investigated the epidemiological and clinical features and factors related to the severity of COVID-19 in one of the less privileged areas in Iran.

Methods

In a multi-center study, all patients admitted to Zahedan University of Medical Sciences hospitals in southeastern Iran were investigated from February 29 to April 31, 2020. Demographic, epidemiological, and clinical data of patients were extracted from medical records. Bivariate and multivariate logistic regression models were used to explore the risk factors associated with the severity of COVID-19.

Results

Among the 413 patients, 55.5% were male, and 145 (35.10%) were in a severe condition at admission time. Multivariate analysis showed that the adjusted odds of the disease severity increased in patients with older age (OR 2.27; 95% CI 1.41–3.65), substance abuse (OR 2.49; 95% CI 1.14–5.43), having one underlying disease (OR 1.52; 95% CI 0.90–2.55), having two underlying disease (OR 2.31; 95% CI 1.19–4.50), and having three or more underlying disease (OR 2.60; 95% CI 1.19–5.66).

Conclusions

COVID-19 was more severe in older patients, patients with a history of substance abuse, and patients with the underlying disease. Understanding the factors affecting the disease severity can help the clinical management of COVID-19, especially in less privileged areas where fewer resources are available.

Study Factors Involved in Maternal Deaths Attributed to COVID-19 in a Disadvantaged Area in Southeast of Iran

Objective: It is a fact that coronavirus disease of 2019 (COVID-19) infection mortality rate is high, but the question is "what is the role of other factors in maternal death with COVID-19?" The present study aimed to understand the factors that prevent women from timely use of healthcare services and also the potential weaknesses of the healthcare system that cause the lack of quality healthcare services for women.

Materials and methods: This case-series study was performed in the southeast of Iran. In total, 12 cases of maternal deaths attributed to COVID-19 were identified through the Iranian Maternal Mortality Surveillance System. The required information was collected through existing verbal autopsy data sets. In some cases, the family members had to be re-contacted and healthcare workers were asked to supply the missing information. The root cause analysis method was employed for data analysis.

Results: From March 2020 to March 2021, the deaths of 12 women were attributed to COVID-19. The majority of these women lived in rural areas (58%) and had a secondary school education level or less (83.3%). The contributing factors were divided into three categories: barriers at the community level (no prenatal care, lack of trust, lack of recognition of the severity of disease, and attribution of symptoms to something else), at the primary health system level, and at the hospital level (fear of staff of being infected, non-compliance with guidelines, lack of team working, and problem with telehealth).

Conclusion: The socio-cultural context and unmet healthcare needs hinder the utilization of available services. Moreover, factors at the level of the healthcare system prevent the timely detection and referral of women with COVID-19 to receive quality healthcare services. Using telehealth also did not help to appropriately triage pregnant women.

The Seroprevalence of COVID-19 in Intravenous Drug Users in Comparison to Non-drug Users

BACKGROUND COVID-19 infection has led to a worldwide pandemic, and new cases are on the rise. Intravenous drug users (IVDU) are presumably at a higher risk of being infected since they have poor personal hygiene, live in groups, and have risky behaviors. The current study aimed to evaluate the seroprevalence of COVID-19 in IVDU in comparison with non-drug users (N-DU). METHODS This cross-sectional study was conducted on 167 IVDU and 134 N-DU. A questionnaire gathering data on demographics, comorbidities, and use of personal protective equipment was administered to all participants. In addition, 5 cc of blood was taken from each individual to test for SARS-CoV-2 specific antibodies (Pishtaz Teb SARS-Cov-2 ELISA kits). RESULTS The mean age of N-DU and IVDU were 38.9 ± 12.9 and 40.38 ± 10.24 years, respectively. COVID-19 seroprevalence in IVDU was 9.7%, and 4.8% in N-DU, but this finding was not statistically significant (p = 0.096). CONCLUSION While the seroprevalence of COVID-19 was not significantly different among the two groups, IVDU should still be considered by policymakers as a high-risk group due to their lifestyle and risky behaviors. Providing personal protective equipment and other means of protection and treatment to this population can help mitigate the spread of and mortality from COVID-19.

Sequence Analysis of Pvama-1 among Plasmodium Vivax Isolates in Sistan-Baluchistan

Background

Apical Membrane antigen 1 (AMA-1) is an important membrane protein that presents in all Plasmodium species and participates in critical phases in the attraction of cells. In human, it is one of the most immunodominant antigens with a protective immune response simulation role Apical Membrane antigen 1 (AMA-1) is an important membrane protein which presents in all Plasmodium species and is located on the surface of merozoite and sporozoites that participates in critical phases in attraction of human red blood cells by merozoites and hepatocytes by sporozoites, so in human, it is one of the most immunodominant antigens with a protective immune response simulation role. Since extra information is necessary to lighten of AMA-1 scope, we equaled genetic variation in P.vivax AMA-1 from 40 Iranian isolates with those reported from the other malarious countries.

Methods

Blood samples were collected from 40 patients' positive of P.vivax, and genomic DNA was extracted from the blood. The nucleotide sequence for 446 amino acid (AA) residues (42-488 of PvAMA-1) of AMA-1 gene was amplified via PCR and then sequenced.

Result

A total of 24 different haplotypes were recognized between samples. No new haplotype was determined in this research that was reported previously in other regions of Iran and the world. We detected 37-point mutations at the nucleotide level in their sequences and showed 43 amino acid variations, at 37 positions in which 6 sites demonstrate trimorphic polymorphism, and the others were dimorphic.

Conclusion

Sequence analysis of the major haplotype showed 95% similarity with P.vivax Sal-1 AMA-1 gene and high level of allelic diversity at the domain I of PvAMA-1 among P. vivax isolates of Iran. Because PvAMA-1 is noticeable as vaccine candidate antigen, these documents provide valuable information for the development of malaria vaccine.

Changes in the morphology of the hyperemic blebs in eyes undergone trabeculectomy with mitomycin C after injection of triamcinolone acetonide during one-year follow-up

PURPOSE

To track changes in the morphology of hyperemic blebs in eyes undergone trabeculectomy with mitomycin C 0.02% (MMC) after triamcinolone acetonide (TA) injection.

METHODS

A total of 30 eyes of 30 patients with localized or diffuse hyperemia after trabeculectomy with MMC were enrolled in this prospective interventional case series. Two milligrams of TA were injected at the site of maximal injection. Bleb morphology was graded using Indiana Bleb Appearance Grading Scale (IBAGS), and the Moorfields Bleb Grading System (MBGS) 1 week, 1 month, 3 months, 6 months, and 1 year after injection. Failure was defined as intraocular pressure (IOP) more than predefined target IOP for each eye, need for an additional surgical procedure, IOP less than 6 mmHg, and loss of Light Perception (LP) vision.

RESULTS

A total of 27 patients completed a 1-year follow-up period and were included in the final analysis. The mean time interval from trabeculectomy to injection of TA was 5.98 ± 2.57 weeks. The bleb height and vascularity in the IBAGS system decreased significantly after the intervention (p < 0.05), with an increase in bleb extension (p = 0.006). Using MBGS, the bleb area did not change significantly following TA injection (p = 0.056) but its height and vascularity significantly decreased in both central and peripheral areas and the surrounding conjunctiva (p = 0.032). The development of a mature cataract was the only complication that could be attributed to TA injection.

CONCLUSION

Injection of TA in hyperemic failing blebs improves bleb morphology by decreasing vascularity and height while increasing the extent with an acceptable safety profile.

Comparison between sutureless scleral tunnel phacotrabeculectomy with and without placement of anterior capsule remnant

PURPOSE

To compare sutureless scleral tunnel phacotrabeculectomy with and without placement of anterior capsule remnant in the tunnel.

METHODS

In this comparative interventional case series, 41 eyes of 40 patients having open-angle glaucoma (OAG) underwent sutureless scleral tunnel phacotrabeculectomy (Group A) and 28 eyes of 24 patients underwent the same procedure with placement of anterior capsule remnant in the tunnel (Group B). Baseline intraocular pressure (IOP) and IOP at 1 day, 1 month and 6 months after surgery were recorded. IOP < 21 mmHg and 20% reduction in IOP from baseline without and with antiglaucoma medication(s) were considered as complete and qualified success, respectively. Any further procedures or complications that require returning the patient to the operating room or becoming no light perception (NLP) were defined as failure.

RESULTS

Mean preoperative IOP was 26.6 ± 10.08 and 26.64 ± 6.31 mmHg in group A and B, respectively (P-value = 0.984). Mean IOP at 1 month was significantly lower in group B (14.24 ± 4.4 versus. 12.07 ± 3.1, P = 0.027) but at 6 months there was no significant difference between groups (14.38 ± 3.56 versus. 14.8 ± 1.85, P = 0.590). The qualified success rate in group B was higher than group A (78.6 versus. 58.5%) at month 1, while the complete success rate was higher in group A than B (34.1% versus. 17.9%). Neither of any group had complete success at month 6. The qualified success rate was 94.7% and 100% in group A and B, respectively, at 6 months.

CONCLUSION

Placement of anterior capsule remnant in the ostomy during combined phacotrabeculectomy may improve the outcome of the procedure.

Bilateral spontaneous filtering blebs

Purpose

To report a case of bilateral spontaneous filtering bleb, scleral thinning, microspherophakia, and mild craniofacial dysmorphism.

Observations

An 18-year-old girl was referred to our clinic for evaluation of bilateral spontaneous filtering blebs. Her corrected distance visual acuity (CDVA) was 20/400 in the right eye (RE) and 20/100 in the left eye (LE). She had superior scleral thinning, multicystic filtering bleb, and microspherophakia bilaterally. The IOP was 9 mmHg in the RE and 8 mmHg in the LE. A mild craniofacial dysmorphism including downward slanting of palpebral fissures and malar hypoplasia was present. There was no sign of corneal ectasia in tomography. Anterior segment optical coherence tomography revealed the filtering blebs as subconjunctival low reflective fluid-filled spaces. Due to severe scleral thinning un the RE we performed a tectonic scleral patch graft. 6 months after surgery the depth of the anterior chamber increased and CDVA improved.

Conclusion and importance

This case indicated that the formation of spontaneous filtering blebs may occur in a syndromic condition. In any case with this symptom, special attention should be paid to craniofacial features, sclera, crystalline lens, and IOP. Tectonic scleral patch graft could be a valuable option in selected patients.

Socioeconomic gradient in physical activity: findings from the PERSIAN cohort study

Background

The level of socioeconomic-related inequality in physical activity in Iran is largely unknown. This study investigates socioeconomic-related inequality in poor-physical activity (PPA) among Iranian adults.

Methods

A total of 129,257 adult participants enrolled in the PERSIAN (Prospective Epidemiological Research Studies in IrAN) Cohort were included in this study. Physical activity of adults was measured using metabolic equivalent rates (METs). Physical activity less than 41 METs/hour/day was considered PPA. The Concentration index (C) was used to quantify socioeconomic-related inequality in PPA. Moreover, the C was decomposed to identify the relative contribution of explanatory variables to inequality in PPA.

Results

There were significant regional variations in physical activity level among Iranian adults (29.8–76.5%). The positive value of C (0.098, 95% CI = 0.092 to 0.104) suggested that the higher concentration of PPA among higher socioeconomic status (SES) adults in Iran which was consistently observed in all cohort sites.

Conclusions

The higher prevalence of PPA among Iranian adults, especially, women and older adults, warrant further public health attention. Since PPA is concentrated more among the high-SES population in Iran, strategies for the promotion of physical activity should focus more on economically well-off population.

Reiteration of the elimination status of measles in the southeast of Iran, 2015

During 2015, the number of measles cases reported from Iran increased about three times the previous year; and Sistan-va-Baluchestan Province, located in the southeast of Iran, was the hottest point at the center of the dilemma. The main objective of the present study was to evaluate the situation of the population with regard to the elimination goals. The files of all measles cases were reviewed and categorized again based on surveillance system definitions; and the effective reproduction numbers, attack rates, and epidemic curves were calculated and graphed. In total, 152 laboratory-confirmed cases occurred in 2015 in the study population. The highest attack rate belonged to infants being in their first year of life and the lowest to the age groups 16 to 40. The estimated 'Effective Reproduction Number' for the eight districts ranged from 0.70 to 0.93; and considering the subsidence of all outbreaks by themselves, it might be speculated that elimination state is still in effect and accountable. Considering the large number of the susceptible islands among the sea of herd immune population, implicated by the large number of outbreaks, implementation of a supplementary immunization intervention is highly recommended.

Dengue Fever as an Emerging Infection in Southeast Iran

Dengue fever (DF) is a mosquito-borne acute viral disease presenting with hemorrhagic manifestations in severe cases. Southeast Iran is in close proximity to Pakistan, an endemic country for DF. This cross-sectional study was conducted in the Sistan and Baluchestan province in the southeast of Iran to investigate possibility of DF (immunoglobulin M [IgM], immunoglobulin G [IgG], and nonstructural protein 1 [NS1] antigen tests) in 60 clinically suspected patients (April 2013 to August 2015). NS1 protein was detected in 5% (N = 3), at least one of the antibodies (IgM and/ or IgG) was detected in 11% (N = 7) of the samples. Five patients identified as of acutely infected. There was a simultaneous presence of NS1 protein and IgG or IgM antibodies in 4% (N = 2) of patients. Previous studies show establishment of potential vectors in this area. These evidences support the hypothesis that DF can be a health concern in Southeast Iran with potential future outbreaks.

Pellet gun injury as a source of ocular trauma; a retrospective review of one hundred and eleven cases

Purpose

To report the demographic data, treatment methods, and outcomes among patients with pellet gun eye injuries.

Methods

This study was a retrospective review of all pellet gun eye injuries coming to Farabi Eye Hospital, a referral ocular trauma center in Iran, from February 2009 to November 2013. Patients' demographics, type of injury, choice of management, complications, and post-treatment visual acuity were recorded.

Results

One hundred eleven patients with a mean age of 25.7 ± 15.6 years entered the study. The most common age group was younger adults (16–45 years old) (61.3%). The mean uncorrected visual acuity after treatment was 2.05 (20/2240) ±1.5 logMAR. The most prevalent ocular zone was zone III (38.7%), and an intraocular foreign body was present in 97 patients (87.4%). Lid laceration and periocular tissue damage were present in 27 patients (24.3%). Lensectomy and vitrectomy were the most common treatment (31.5%). In most patients (87.4%), the injury was non-deliberate, and the most common time of hospitalization was the same day (45.0%). The only statistically significant indicator of post-treatment visual acuity was ocular trauma score (OTS) at admission (P < 0.001). At the end of follow-up, enucleation was performed for 20 patients (18%), and thirty-six patients (32%) had no light perception (NLP) in vision.

Conclusion

Pellet gun injuries were more common among young male patients, and the only statistically significant indicator of post-treatment visual acuity was OTS at admission.

The effect of relaxation techniques on edema, anxiety and depression in post-mastectomy lymphedema patients undergoing comprehensive decongestive therapy: A clinical trial

Objectives

Lymphedema is sometimes accompanied by high degrees of anxiety and depression. This study aimed to assess the effects of relaxation techniques on the level of edema, anxiety and depression in women undergoing Comprehensive Decongestive Therapy (CDT).

Design

This clinical trial compared two treatment methods in 31 women with post-mastectomy lymphedema, including 15 cases who received CDT and 16 who received RCDT (Relaxation plus CDT). The edema volume, anxiety and depression scores were compared at the first and last sessions of the first phase of the treatment and six weeks afterwards.

Results

The edema, anxiety and depression scores were 63.6%, 54.1% and 65.5% in the RCDT group and 60.7%, 31.4% and 35.2% in the CDT group. There were significant differences between the two groups in terms of the reduction in depression (p = 0.024) and anxiety (p = 0.011) scores throughout the study. This significant relationship was due to the differences in the depression score in the 3^rd and 9^th weeks of the study between the two groups. Similarly, anxiety levels differed significantly between the two groups at the 9^th week of the study (P = 0.013).

Conclusion

Relaxation techniques reduced the anxiety and depression scores and the volume of edema in the patients with lymphedema. The addition of this intervention to the therapeutic package for lymphedema patients requires further studies in terms of cost-effectiveness.

Head-to-head immunogenicity comparison of Edmonston-Zagreb vs. AIK-C measles vaccine strains in infants aged 8-12 months: A randomized clinical trial

BACKGROUND

A non-inferiority multi-centre parallel randomized double-blind trial was implemented in Zahedan district, Sistan-va-Baluchestan province, Iran, to compare the performance of the two measles vaccines which are in use in the National Immunization Programme of Iran and are of two different measles virus vaccine strains: Edmonston-Zagreb (EZ) strain vs. AIK-C strain. The main outcome measure was appearance of anti-measles antibody in sera.

METHODS

200 infants, 8-12 months old, whose parents consented for their children to be included in the study, were randomized in permutation blocks of size 4-8 in four Urban Health Clinics. Having given a pre-vaccination blood sample, they received measles-rubella vaccine containing one of the vaccine strains mentioned before. After 60 days, the second blood sample was taken. The sera of the pre- and post-vaccination blood samples were tested for anti-measles antibodies in the National Reference Measles Laboratory. Parents, laboratory technicians and statistician were blind to groupings.

RESULTS

Of the 200 children equally randomized in the two arms, 185 who were seronegative before vaccination (88 in the EZ arm and 97 in the AIK-C arm) were entered in the final analysis. The seroconversion rate in the EZ arm was 76.1% (95% CI: 60.2-85.2%), and that in the AIK-C arm was 58.7%; (95% CI: 48.8-68.7%). The absolute rate difference was 17. 4% (4.1-30.9%; P-value: .012), and the relative seroconversion rate of EZ to AIK-C was 1.3 (95% CI: 1.1-1.6; P-value: .012). No adverse events were reported during the study period.

CONCLUSION

A considerable difference in the seropositivity of different measles containing vaccines could be demonstrated in the first year of life.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials Registration Number: IRCT2016032827144N1; May 10, 2016 (www.who.int/ictrp/network/irct/en/).

Seroepidemiology and risk factors of Crimean-Congo Hemorrhagic Fever among butchers and slaughterhouse workers in southeastern Iran

OBJECTIVE

Crimean-Congo Haemorrhagic Fever (CCHF) is a viral zoonotic disease. Butchers and slaughterhouse workers are considered to be high risk occupational groups for the disease. Sistan and Baluchistan province is an area in southeastern Iran which is endemic for CCHF, and the most confirmed cases of the disease are reported from this province. The aim of this study was to investigate the seroprevalence of CCHF and risk factors for seropositivity among them in Sistan and Baluchistan province in 2011.

METHODS

Questionnaire data and blood sample collection were carried out for each participant and the sera samples were sent to the national reference laboratory for ELISA IgG testing.

RESULTS

In this study, the seroprevalence of CCHF among 190 butchers and slaughterhouse workers from 11 counties was 16.49%. 79% of participants were aware that they were at risk of zoonosis and 39.7% did not use any personal protective equipment during their work. Of 31 CCHF IgG positive individuals in this study, eleven individuals had a previous record of CCHF infection in 57 months prior to the study.

CONCLUSIONS

High seroprevalence of CCHF among butchers and slaughterhouse workers and minimal use of personal protective equipment's during daily work indicates the need for training courses, for these groups to increase their knowledge, attitude and practice with respect to zoonosis.

Radioprotective Effect of Beta D-Glucan and Vitamin E on Gamma Irradiated Mouse

INTRODUCTION

It is shown that beta-D-glucan is an immunologic system booster with radioprotectory effects. Radioprotectors are chemical components that can alleviate biological damage produced by ionizing radiation.

AIM

This study was designed to investigate the synergistic radioprotectory effects of beta-D-glucan and vitamin E on irradiated mice with ⁶⁰Co source.

MATERIALS AND METHODS

A total of 240 female mice were arranged in four, equal population groups of control group (C), treated group with beta D-glucan (G), treated group with vitamin E (E), and treated group with both beta D-glucan and vitamin E (G+E). Each group was divided into three equal population groups of D6, D7 and D8 exposed to ⁶⁰Co radiation with prescribed total body dose of 6, 7 and 8 Gray (Gy), respectively. After the exposure, the number of survived animals was counted by time, then Lethal Dose_50/30 (LD_50/30), Lethal Dose_50/60 (LD_50/60) and Dose Reduction Factor (DRF) were calculated in all groups and corresponding groups.

RESULTS

Based on the results of current study, treatment of the animals with vitamin E did not change values of LD_50/30 and LD_50/60, in comparison to control group. LD_50/30 and LD_50/60 of treated groups with beta D-glucan and beta D-glucan + vitamin E showed significant difference with those of control group (p<0.01). The DRF values in groups E, G and G + E, were calculated respectively as 1, 1.25 and 1.375 based on LD_50/30, and respectively as 1, 1.17 and 1.33 based on LD_50/60. While values of DRF in groups G and G + E showed significant difference in comparison to that of control group (p<0.01), but the difference between DRF of groups G and G + E was not significant (p=0.395).

CONCLUSION

The findings of study obviously showed that, presence of beta D-glucan in the body of mice, during exposure to ionizing radiation, leads to DRF of higher than one, proving the radioprotectory effect of this agent. Also, we demonstrated that, while vitamin E had no radioprotectory effect on irradiated mice, beta D-glucan in combination with vitamin E increased resistance of mice against ionizing radiation.

Prevalence of Addiction and Smoking and Their Relationship With Blood Parameters Among Drivers in Zahedan

Background

Although smoking and drug use are the major causes of accidents and death of drivers, few studies have been conducted on the prevalence of smoking and its associated factors in this occupational group.

Objectives

The current study aimed to investigate the prevalence of smoking and its relationship with blood parameters among drivers in Zahedan city, Iran.

Patients and Methods

In this study, 1836 inner and intercity drivers were investigated in 2013 in terms of smoking and drug use and blood parameters. Data were obtained through in-depth interviews and necessary examinations and tests, and were analyzed by Stata.12 software using Chi-square, independent t-test, and multiple regression analysis at significance level of 0.05.

Results

Generally, four drivers were addicted to drugs and smoked as well. Two-hundred and eighty eight drivers (15.8%) reported daily smoking. Variables of age, education, and type of vehicle showed a significant relationship with smoking. No significant difference was found in blood parameters between the smokers and non-smokers.

Conclusions

Despite relatively high prevalence of smoking than drug use in Zahedan drivers, there are few reports of these behaviors. Laboratory tests cannot suitably measure substance use due to their interference with other substances. Considering adverse effects of smoking on health and driving, it is necessary to train drivers to reduce or stop smoking during driving.

Birth outcomes in a tertiary teaching hospitals and local outposts: a novel approach to service delivery from Iran

OBJECTIVE

The aim of this study was to compare the outcomes of childbirth care in a tertiary teaching hospital and Safe Delivery Posts (SDPs) to determine the safety of out-of-hospital care by midwives in Zahedan, Iran.

STUDY DESIGN

A quasi-experimental design was applied in this study.

METHODS

In this study, 2063 women who gave birth in SDPs, along with 983 women who underwent vaginal delivery in a tertiary teaching hospital, were evaluated in 2011-2012. Retrospective chart review was applied to collect data from the medical records of mothers and neonates. Only low-risk women with a singleton live birth, cephalic presentation, gestational age ≥37 weeks, spontaneous labour, and no prior history of uterine scar were recruited.

RESULTS

Based on the findings, episiotomy, perineal tear, cervical laceration, postpartum haemorrhage and need for blood transfusion (or hysterectomy) were less commonly reported in the SDP group, compared to the hospital group. In the SDP group, 15 (0.73%) women were transferred to the hospital after delivery. Overall, one (0.10%) case from the hospital group and two (0.10%) cases from the SDP group were admitted to the intensive care unit. One-minute Apgar score lower than seven, resuscitation, NICU admission and neonatal death were more commonly reported in the hospital group, compared to the SDP group. Overall, hospital transfer was reported in 12 (0.58%) neonates born in SDPs.

CONCLUSION

In the present study, women who gave birth in SDPs had more opportunities to experience natural birth with fewer adverse outcomes. However, considering the possibility of life-threatening complications for mothers and newborns, substantial evidence is required to improve the quality of care before implementing such novel strategies in different settings.

Epidemiological aspects of ocular superglue injuries

AIM

To report the frequency, associated risk factors and characteristics of cases referred to Farabi Eye Hospital with ocular superglue injuries.

METHODS

In a descriptive cross-sectional study conducted between December 2012 and February 2013, patients with ocular superglue injuries were evaluated. Age, sex, educational level, location, time, mechanism, type, site and time of eye injury were gathered through interview using a customized questionnaire. All participants had given consent to undergo thorough eye examination.

RESULTS

Over the course of three months, 105 patients with ocular superglue injuries enrolled in the study, including 56(53.3%) men and 49(46.7%) women with the mean age of 24.7±11.6 (range, 2 to 53)y. The right eye, left eye and both eyes were involved in 52%, 42% and 6% of the patients, respectively. Most of injuries had occurred at home (72.4%) and at night (55%). More than half of patients (52.4%) did not take any primary aids following the ocular injury. Patient carelessness (78.1%), childhood curiosity and lack of parental supervision (11.4%), storing superglue in inappropriate places and inadvertently using superglue as eye drops due to poor vision (2.9%), inadequate awareness of superglue applications [used to stick on artificial nails (3.8%), artificial eyelashes (1.9%) and broken tooth (1%)] and being assaulted with glue (1%) were common risk factors.

CONCLUSION

The frequency of ocular superglue injuries in patients referred to Farabi Eye Hospital is relatively high. This finding underlines the importance of public education and awareness about superglue injuries to the eye and taking protective measures and safety strategies in order to prevent these injures.

Predicting factors for malaria re-introduction: an applied model in an elimination setting to prevent malaria outbreaks

BACKGROUND

Malaria re-introduction is a challenge in elimination settings. To prevent re-introduction, receptivity, vulnerability, and health system capacity of foci should be monitored using appropriate tools. This study aimed to design an applicable model to monitor predicting factors of re-introduction of malaria in highly prone areas.

METHODS

This exploratory, descriptive study was conducted in a pre-elimination setting with a high-risk of malaria transmission re-introduction. By using nominal group technique and literature review, a list of predicting indicators for malaria re-introduction and outbreak was defined. Accordingly, a checklist was developed and completed in the field for foci affected by re-introduction and for cleared-up foci as a control group, for a period of 12 weeks before re-introduction and for the same period in the previous year. Using field data and analytic hierarchical process (AHP), each variable and its sub-categories were weighted, and by calculating geometric means for each sub-category, score of corresponding cells of interaction matrices, lower and upper threshold of different risks strata, including low and mild risk of re-introduction and moderate and high risk of malaria outbreaks, were determined. The developed predictive model was calibrated through resampling with different sets of explanatory variables using R software. Sensitivity and specificity of the model were calculated based on new samples.

RESULTS

Twenty explanatory predictive variables of malaria re-introduction were identified and a predictive model was developed. Unpermitted immigrants from endemic neighbouring countries were determined as a pivotal factor (AHP score: 0.181). Moreover, quality of population movement (0.114), following malaria transmission season (0.088), average daily minimum temperature in the previous 8 weeks (0.062), an outdoor resting shelter for vectors (0.045), and rainfall (0.042) were determined. Positive and negative predictive values of the model were 81.8 and 100 %, respectively.

CONCLUSIONS

This study introduced a new, simple, yet reliable model to forecast malaria re-introduction and outbreaks eight weeks in advance in pre-elimination and elimination settings. The model incorporates comprehensive deterministic factors that can easily be measured in the field, thereby facilitating preventive measures.

Breast-feeding Continuation in South-Eastern of Iran: the Associated Factors

Background:

Breast-feeding not only promotes health in an infancy period, but also leads to human vigor and safety at varied life periods viz. adolescence, youth, middle-age, or even adulthood.

Aim:

The present study was aimed to determine the factors affecting the breast-feeding continuation effectively for a selected region of Iran.

Methods:

This cross-sectional study was performed on 523 women having less than two year old babies from the selected counties covered by the Zahedan University of Medical Sciences (Khash, Saravan, Sarbaz, Chabahar, Zahedan, Nikshahr, Iranshahr, and Konark) using the stratified sampling method. The Data was completed for the target group by using the check-list which included 3 parts: demographic data, case history of pregnancy, childbirth and mother’s statue, and previous records of the newborn up to two years. The obtained data were fed into SPSS software, and all parametric and non-parametric statistical methods were used to analyze the data, especially appropriate to the data type.

Results:

The results showed that the most important factors associated with breast-feeding discontinuation were infant’s illness (only up to six months), mother’s consciousness, parental support, practical breastfeeding training to the mother, mother’s educational level, child’s gender, place of birth, pregnancies’ interval, mother’s ethnicity and residence and the statue of taking (using) narcotics. The data also indicated that on maternal reasons the main factor which impelled most of the mothers to discontinue their breast-feeding up to six months or even before two years was milk shortage in mother’s breasts. Moreover, the main child- related factor that compelled most of the mothers for non-continuance of their breast-feeding up to six months or even before two years was child’s crying and discomfort.

Conclusions:

It can be safely concluded that promotion of parental education, neglecting child’s gender as far as cultural context and preference of a son is considered, observance of pregnancy interval for more than three years, non-smoking in nursing mothers, practical training of breast-feeding to mothers besides conductance of educative programs via maternity hospitals and health centers to educate parents about the importance of breast-feeding and benefits of spouse’s support can be considered as the influential factors in continuation of breast-feeding.

Prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in southeast Iran: implications for malaria elimination

INTRODUCTION

Glucose-6-phosphate dehydrogenase deficiency (G6PD) is an X-linked genetic disorder with a relatively high frequency in malaria-endemic regions. It is an obstacle to malaria elimination, as primaquine administered in the treatment of malaria can cause hemolysis in G6PD-deficient individuals. This study presents information on the prevalence of G6PD deficiency in Sistan and Balouchetsan province, which hosts more than 90% of Plasmodium vivax malaria cases in Iran. This type of information is needed for a successful malaria elimination program.

METHODOLOGY

A total of 526 students were randomly recruited through schools located in southeast Iran. Information was collected by interviewing the students using a structured questionnaire. Blood samples taken on filter papers were examined for G6PD deficiency using the fluorescent spot test.

RESULTS

Overall, 72.8% (383/526) of the subjects showed normal G6PD enzyme function. Mild and severe G6PD deficiency was observed in 14.8% (78) and 12.2% (64) of subjects, respectively. A total 193/261 males (73.9%) and 190/265 (72%) females had normal enzyme activity. Mild G6PD deficiency was observed in 10.8% (28) and 18.9% (50) of male and female subjects, respectively. However, in comparison with females, a greater proportion of males showed severe enzyme deficiency (15.3% versus 9.1%). All these differences were statistically significant (p < 0.006).

CONCLUSIONS

G6PD deficiency is highly prevalent in southeast Iran. G6PD-deficient individuals are susceptible to potentially severe and life-threatening hemolytic reactions after primaquine treatment. In order to achieve malaria elimination goals in the province, G6PD testing needs to be made routinely available within the health system.

Population attributable danger of hereditary heart breaks. Risk factors among newborns in Yazd, Iran

Background: hereditary heart problem are cardiac problems that develop prior to birth and influence the newborns' basic performance of heart. Different kinds of deficiency can range from mild (e.g. a small hole between the heart chambers) to severe (like a flaw or weakness into a heart part). Material & Method: This case-control research performed to evaluate PAR congenital heart defects danger parameters between newborns from 2012 to 2013 in Yazd hospitals. The defects were identified through echocardiography and recorded based on the 10th Revision of Diseases International Classification (DIC10). The total amount of cases were 96, of whom 14 were excluded regarding that the shortage of cooperation or insufficient data. One hundred and sixty five sex and region matched controls selected through random sampling involved in the research. Population Attributable Risk (PAR) utilized to evaluate and measure the priorities of the danger parameters. Finally, the Levin formula utilized to evaluate the regulate community ascribable portion. Result: Regulated odds rates evaluated for the danger parameters. The outcomes revealed that the greatest odds ratio belonged to the maternal history of stillbirth, lack of multivitamin use before pregnancy, maternal obesity, and overweight. The calculation of the adjusted Population Attributable Fraction in risk factors indicated that the highest fraction of the causes of natural heart malformations was associated with overweight and obesity. Conclusion: The current research showed that several factors that can impact the congenital heart defects. It concluded that although overweight and obesity had a weaker association than the other 2 parameters, they have a higher prevalence and a greater attributable risk.

Epidemiology of Suicide and its Associated Socio-demographic Factors in Patients Admitted to Emergency Department of Zahedan Khatam-Al-Anbia Hospital

Background:

Suicide is a growing public health problem all over the world. Understanding the prevalence of suicide and its correlates is of great importance in planning programs to reduce the risk in different societies.

Objectives:

The present study was conducted to assess the epidemiology of suicide and its associated risk factors in Sistan and Balouchestan Province, southeast of Iran.

Patients and Methods:

We investigated a total of 369 suicide cases admitted to the emergency department of Zahedan Khatam- Al- Anbia hospital between March 2010 and February 2012. Data was collected from the hospital information system (HIS) using a semi-structured questionnaire. Descriptive statistics and chi-square tests were used to identify the factors associated with suicidal behaviors.

Results:

A greater proportion of the study subjects (65%) were female. They were more likely to be young (43.5% in the age group of 16 to 25 years) and illiterate or have a primary school education (20.9% and 48.8%, respectively). Housewives and self-employed individuals and those with a low or medium income dominated the suicide cases. The most common method of suicide was burning (53.4%) followed by drug ingestion (23.8%). One third of the suicide cases occurred during spring. The case fatality rate was 49.6% and it was significantly associated with low income, summer time suicides, burning as a method of suicide.

Conclusions:

This study highlights the burden of suicide and itspotential socio-demographic risk factors in Sistan and Blouchestan Province. This information has an implication for planning the preventive measures, policy making and future research.

Tea, coffee, and milk consumption and colorectal cancer risk

BACKGROUND

Data regarding the effects of tea, coffee, and milk on the risk of colorectal cancer are inconsistent. We investigated associations of tea, coffee, and milk consumption with colorectal cancer risk and attempted to determine if these exposures were differentially associated with the risks of proximal colon, distal colon, and rectal cancers.

METHODS

Data from 854 incident cases and 948 controls were analyzed in a case-control study of colorectal cancer in Western Australia during 2005-07. Multivariable logistic regression was used to analyze the associations of black tea (with and without milk), green tea, herbal tea, hot coffee, iced coffee, and milk with colorectal cancer.

RESULTS

Consumption of 1 or more cups of herbal tea per week was associated with a significantly decreased risk of distal colon cancer (adjusted odds ratio, 0.37; 95% CI, 0.16-0.82; PTrend = 0.044), and consumption of 1 or more cups of iced coffee per week was associated with increased risk of rectal cancer (adjusted odds ratio, 1.52; 95% CI, 0.91-2.54; PTrend = 0.004). Neither herbal tea nor iced coffee was associated with the risk of proximal colon cancer. Hot coffee was associated with a possible increased risk of distal colon cancer. Black tea (with or without milk), green tea, decaffeinated coffee, and milk were not significantly associated with colorectal cancer risk.

CONCLUSIONS

Consumption of herbal tea was associated with reduced risk of distal colon cancer, and consumption of iced coffee was associated with increased rectal cancer risk.

Rhazes' prescriptions in treatment of gout

BACKGROUND

Among the diseases that clinicians deal with, few do have a documented medical history that can be traced back to several centuries ago. A careful study of Rhazes' Treatments on Gout reveals a lot about the nature and therapy of gout.

METHODS

We managed to study the perceptions about pathogenesis, symptomatology, diagnosis, and treatment of gout that have changed over time. We also discussed some of the past and present fallacies regarding this disease.

RESULTS

Rhazes provided a detailed description on the vital role of genetics and the relationship between the development of gout, an indulgent way of living, and tophi at a period of time between 1st and 6th centuries AD.

CONCLUSION

This study showed that the findings of Rhazes about treatments of gout were consonant with modern medical theories.

Dietary benzo[a]pyrene intake from meat and the risk of colorectal cancer

INTRODUCTION

One possible mechanism for the postulated link between high consumption of meat and colorectal cancer (CRC) is the content of benzo[a]pyrene (BaP) in meat.

METHODS

We investigated this association in a population-based case-control study in Western Australia (567 cases and 713 controls). Participants' self-report of meat consumption and lifestyle was used in conjunction with the CHARRED carcinogen database to estimate their BaP intake.

RESULTS

Dietary exposure to BaP from meat consumption was not associated with the risk of CRC.

CONCLUSIONS

Our findings do not support the hypothesis that BaP exposure from meat consumption is a risk factor for CRC. IMPACT STATEMENT: This large-scale case-control study used a detailed meat questionnaire in conjunction with the CHARRED database in a large population with high meat intake but was unable to find any association between intake of BaP and colorectal cancer.

Electroviscous sphere–wall interactions

A theoretical analysis is presented to determine the forces of interaction between an electrically charged spherical particle and a charged plane wall when the particle translates parallel to the wall and rotates around its axis in a symmetric electrolyte solution at rest. The electroviscous effects, arising from the coupling between the electrical and hydrodynamic equations, are determined as a solution of three partial differential equations, derived from Cox's general theory [R.G. Cox, J. Fluid Mech. 338 (1997) 1], for electroviscous ion concentration, electroviscous potential and electroviscous flow field. It is a priori assumed that the double layer thickness surrounding each charged surfaces is much smaller than the particle size. Using the matched asymptotic expansion technique, the electroviscous forces experienced by the sphere are explicitly determined analytically for small particle-wall distances, but low and intermediate Peclet numbers.

Electroviscous cylinder–wall interactions

A theoretical analysis is presented to determine the forces of interaction between an electrically charged cylindrical particle and a charged plane boundary wall when the particle translates parallel to the wall and rotates around its axis in a symmetric electrolyte solution at rest. The electroviscous effects, arising from the coupling between the electrical and hydrodynamic equations, are determined as a solution of three partial differential equations, derived from R.G. Cox's general theory [J. Fluid Mech. 338 (1997) 1], for electroviscous ion concentration, electroviscous potential, and electroviscous flow field. It is assumed a priori that the double layer thickness surrounding each charged surface is much smaller than the length scale of the problem. Using the matched asymptotic expansion technique, the electroviscous forces experienced by the cylinder are explicitly determined analytically for small particle-wall distances for low and intermediate Peclet numbers. It is found that the tangential force usually increases the drag above the purely hydrodynamic drag, although for certain conditions the drag can be reduced. Similarly the normal force is usually repulsive, i.e., it is an electrokinetic lift force, but under certain conditions the normal force can be attractive.