New assessment of relationship between Apgar score and early neonatal mortality.

AIM: Apgar scoring system was proposed in 1952 for evaluating the physical condition of neonates at 1 and 5 minutes after delivery. We designed this study to examine the original intent of Apgar system to predict neonatal survival during almost 50 years of its application. METHODS: We carried out a prospective cohort analysis of 1161 live born term neonates delivered by cesarean section at 37 weeks of gestation or later at Khoram-abad Asali hospital in Iran during 2003 to 2005. Apgar score in 1 and 5 minutes after delivery were determined and charted. We evaluated two groups, neonates with Apgar score of equal or more than 5 in 5 minute after birth, and the ones with less than 5. The relation between neonatal mortality during first 48 hours after birth and 5 minute Apgar score was assessed. All analysis was performed with SPSS Software and chi(2) test. RESULTS: In 1161 neonates, 8 were with five minute Apgar score less than 5, and their mortality rate in first 48 hours after birth was 5, as compared with 13 in 1153 for neonates with 5 minute Apgar score equal or more than 5. Neonatal mortality rate was 625 in 1000 for neonates with 5 minute Apgar score less than 5 and 11.4 in 1000 for infants with score equal or more than 5. There was statistically significance between two groups (P approximately = 0.0001). CONCLUSION: Apgar score is still as meaningful as it was in 1952. Apgar score after birth can be used as a rapid method for assessing the survival of neonate. Although low 5 minute Scores were rare in this study but there was strongly predictive relation between it and early neonatal mortality.

The lipid quality assessment of Schizothorax zarudnyi and Schizocypris altidorsalis by fatty acid analysis.

The proximate and fatty acid composition of two locally important freshwater fish, Schizothorax zarudnyi and Schizocypris altidorsalis, from Sistan Province in Iran were investigated for their nutritional value. The protein and lipid content in the S. zarudnyi were 14.67 and 6.36%, respectively. In S. altidorsalis, protein and lipid content were 13.03 and 4.52%. There was quantitative difference between individual fatty acids of these two fish. Totally 18 fatty acids were found. In S. zarudnyi, DHA was the highest among the poly-unsaturated fatty acids with 42.85%, followed by EPA with 29.62% of the total poly-unsaturated fraction. In S. altidorsalis, EPA was the highest among the poly-unsaturated fatty acids with 45.05%, followed by DHA with 27.87% the total poly-unsaturated fraction. The n-6/n-3 ratio was 0.26 and 0.20 for S. zarudnyi and S. altidorsalis, respectively. High n-3 fatty acids content in these fish revealed that they have high nutritional value. Schizothorax zarudnyi showed better nutritional value in comparison to protein and lipid content of S. altidorsalis.

Gene polymorphism in transforming growth factor-beta codon 10 is associated with susceptibility to Giardiasis.

Secretory immunoglobulin A (S-IgA) antibodies have a central role in anti-Giardial defence. It has been demonstrated that transforming growth factor-beta1 (TGF-beta1) stimulates B lymphocytes to produce and secrete S-IgA. We sought to determine the association between TGF-beta1 polymorphism (T+869C) with susceptibility to Giardiasis. The TGF-beta1 genotypes and levels of salivary (S-IgA) were analysed in individuals with Giardiasis (97 symptomatic and 57 asymptomatic) and controls (n = 92). Individuals with symptomatic Giardiasis had the lowest levels of S-IgA compared to individuals in asymptomatic Giardiasis and control groups (97%, 73% and 43%, <1 g L(-1), respectively, P = 0.002). The frequency of allele C and CC genotypes of TGF-beta1 polymorphism was significantly higher among symptomatic patients than asymptomatic and control groups. Logistic regression analysis demonstrated that the individuals homozygous for allele C of TGF-beta1 had a significantly higher risk for symptomatic Giardiasis with odds ratio of 2.76 (95% CI: 3.88, 1.71, P = 0.007). Among the participants with TT genotype per cent of individuals with S-IgA level of more than 1 g L(-1) was almost twice the percentage in CC genotype individuals (14% versus 7% respectively P = 0.01). Our data suggest that CC genotype of TGF-beta1 polymorphism at codon 10 is associated with occurrence of Giardiasis.

Effect of yttria addition on mechanical, physical and biological properties of bioactive MgO-CaO-SiO2-P2O5-CaF2 glass ceramic.

Preparation of the bioactive MgO-CaO-SiO2-P2O5-CaF2 glass was carried out utilizing tap casting and powder metallurgy methods. The original composition was modified with 0.2% Y2O3 and carbon additions. The mother and the modified bioglass were examined, and comparative studies were performed between the mother and modified type to study the compositional modification effects on physical, mechanical and biological properties. The histology of mother type showed that this type has a good biocompatibility with no rejection or inflammation reaction with the host bone, and new bone generation and formation were shown in the region of implant. The modification with 0.2% Y2O3 achieved a good improvement in the mechanical properties when compared with the mother system. The histology of this type showed a normal acceptance with no inflammation reactions. On the other hand, the modification with carbon achieved a superior improvement in the mechanical properties compared to the mother bioglass and showed a good acceptance with no inflammation reactions with the host body as well.

Slow graft function after pediatric renal transplantation from volunteer live donors.

Slow graft function (SGF) may occur during the early post-transplant period. In this paper, we present our findings regarding SGF after pediatric renal transplantation and its predictive variables. From 1985 to 2004, a total of 300 pediatric renal transplants were performed at our institution. A total of 10 cases with SGF and 50 controls that were operated by the same surgeons were enrolled in this study. The mean age of the recipients and donors was 11.4 (3-15 yr) and 28.05 yr (20-50 yr), respectively. All kidneys were retrieved from living donors. We compared patients with SGF with controls regarding four independent variables: age difference between donors and recipients, serum hemoglobin difference between donors and recipients, mean blood pressure (systolic blood pressure + 2 [diastolic blood pressure]/3) difference between donors and recipients, and weight difference between donors and recipients. The mean age of recipients was 10.5 +/- 4.1 in SGF group and 11.6 +/- 2.5 in control group (p = 0.4). The differences between donors and recipients regarding weight and mean blood pressure in subjects with SGF were not higher than other patients (42 kg vs. 37.4 kg, p = 0.4; -3 mmHg vs. -4.1 mmHg, p = 0.8). The mean hemoglobin difference between donors and recipients was 6.3 +/- 2.1 g/dL in SGF group and 6.7 +/- 2.3 g/dL in control group (p = 0.6). The differences between donors and recipients regarding age, weight, mean blood pressure and serum hemoglobin level are not predictive variables for SGF.

Polymorphism in the promoter region of the CD14 gene and susceptibility to Brucellosis.

A single-nucleotide polymorphism in the promoter region of the CD14 gene at position 159 has been implicated in susceptibility to infectious diseases. We sought to determine the association between CD14 C-159 T functional promoter polymorphism and brucellosis in Western Iranian population where the disease is endemic. The CD14 genotype was determined in 228 patients with brucellosis from a rural area and 129 healthy volunteers from the same area. The prevalence of genotype TT was significantly higher in the patients while the controls showed higher prevalence of genotype CC (34.5% vs 15.5%, 15.4% vs 25.6%, P = 0.009). Multiple logistic regression analysis after adjustment for gender demonstrated that the patients who were homozygous for allele T of promoter of CD14 gene had a significantly higher risk for developing brucellosis with odds ratio of 3.03 (95% CI, 5.2, 1.75 P = 0.0004). The existence of homozygous genotype of allele T of CD14 was an independent determinant for occurrence of arthritis among the patients with brucellosis (odds ratio of 3.92 (95% CI, 2.93, 5.88, P = 0.001).Our findings provide suggestive evidence of association of the CD14 gene polymorphism with susceptibility to development of brucellosis in Iranian populations.

TLR4 polymorphism in Iranian patients with brucellosis.

OBJECTIVE: Brucellosis is a zoonosis of both public health and economic significance in most developing countries. Polymorphisms in Toll-like receptor-4 (TLR4) have been reported to be associated with a blunted immune response to microbial pathogens. Information regarding any association between genetic variation of TLR4 and susceptibility to brucellosis is not available in the literatures. The main purpose of this research is to evaluate the role of polymorphic alleles of TLR4 gene in susceptibility to brucellosis. MATERIALS AND METHODS: In this case-control study, 198 patients with brucellosis and 111 healthy volunteers matched for sex, age and geographic area were evaluated by genotyping for polymorphism in TLR4 gene (Asp299Gly) using amplification refractory mutation system (ARMS)-PCR method. RESULTS: Allele 896G was more prevalent in patients with brucellosis compared to healthy controls (33.6% vs. 20.7%, P=0.000003). Also the frequency of G allele of TLR4 gene was significantly higher in male patients with brucellosis compared to the same sex in control group (36% vs. 21.7%, P=0.00005). Multiple logistic regression analysis demonstrated that male patients heterozygous at allele G gene had a significantly higher risk for brucellosis with an odds ratio of OR 2.89, 95% CI: 1.79-4.69, P<0.0001). CONCLUSION: This study is the first to show an association between genetic polymorphism in TLR4 gene and susceptibility to brucellosis.

Association of increased ferritin with premature coronary stenosis in men.

BACKGROUND: Body iron status has been implicated in atherosclerotic cardiovascular disease. The main hypothesis is that high iron status is associated with increased oxidation of LDL. We investigated the potential role of ferritin as an additional risk factor promoting atherosclerosis among a young population with coronary artery disease (CAD). METHODS: Four hundred consecutive patients (218 males, 182 females) referred for diagnostic coronary angiography were examined, and risk factors for CAD, lipids, C-reactive protein (CRP), and ferritin concentrations were recorded for all participants. RESULTS: Ferritin was higher in the male patients with CAD (121 microg/L; range, 56-258 microg/L) than in the men without significant CAD (73 microg/L; range, 32-138 microg/L; P <0.002). Multiple logistic regression analysis, after adjustment for the established coronary risk factors, showed ferritin as an independent discriminating risk factor for CAD (P <0.01). Men in the highest quartile of ferritin had an odds ratio (OR) of 1.62 [95% confidence interval (95% CI), 1.12-2.42; P <0.01] compared with men in the lowest quartile of ferritin. The association between ferritin and CAD was more pronounced in male patients < or =50 years (OR = 2.65; 95% CI, 1.35-5.51; P <0.003). Ferritin was significantly higher in diabetic male patients in comparison with nondiabetic male patients [168 microg/L (range, 74-406 microg/L) vs 106 microg/L (range, 44-221 microg/L), respectively; P <0.002]. No association was observed between ferritin and CAD among the female patients. CONCLUSION: Our data suggest that increased ferritin might be an independent predictor of premature CAD in male Iranian patients.

Evaluation of C-reactive protein, a sensitive marker of inflammation, as a risk factor for stable coronary artery disease.

OBJECTIVES: Multiple lines of investigations have converged to suggest a prominent role for inflammation in coronary artery disease (CAD). The association of CRP level with active CAD is well documented. The relation, however, between levels of CRP and the presence and extent of stable CAD has seldom been studied in the developing countries. We investigated the association between serum concentration of C-reactive protein (CRP) and angiographically documented coronary artery disease (CAD) in a population of 450 individuals. DESIGN AND METHODS: Ultrasensitive immunoassay was used to measure CRP levels in 284 patients with CAD and 166 control healthy subjects. The association of CRP levels with severity of disease as indicated by > or = 50% stenosis in one vessel (n = 79), two vessels (n = 74), or three vessels (n = 131) was also investigated. RESULTS: CRP levels were greater in the patients with CAD (2.14 (0.88--3.38) vs. 1.45 (0.70--2.55) mg/L, p < 0.0001) than in the respective control subjects. Multiple logistic regression analysis showed CRP as an independent discriminating risk factor for CAD (odds ratio, 3.46, p < 0.001). Significant correlation was identified between CRP levels and severity of CAD (p < 0.0001). Prediction models that incorporated CRP in addition to other established coronary risk factors were significantly better at predicting risk than the models based on the other risk factors alone. CRP level was also an independent predictor of CAD in a subpopulation with normal levels of low density lipoprotein cholesterol (LDL-C < or = 3.4 mmol/L, p < 0.009). CONCLUSIONS: Our findings suggest that CRP has a strong association with stable CAD, as such, the measurement of CRP may improve the coronary risk assessment in Iranian CAD patients.

Enhanced susceptibility to oxidation and diminished vitamin E content of LDL from patients with stable coronary artery disease.

BACKGROUND: Convincing evidence points to oxidative modification of LDL as an important trigger in a complex chain of events leading to atherosclerosis. We investigated the occurrence of enhanced susceptibility of LDL to oxidation and decreased vitamin E concentration in LDL as additional risk factors promoting atherosclerosis among patients with established coronary artery disease (CAD). METHODS: We examined 132 patients with angiographically confirmed CAD and compared them with 111 healthy control individuals. We measured conjugated diene production to assess susceptibility of LDL to copper-mediated oxidation. Vitamin E content of LDL was measured by HPLC. RESULTS: The mean lag time of LDL oxidation and LDL alpha-tocopherol/LDL-cholesterol ratio were lower in the patients with CAD (55 +/- 14 min and 2.4 +/- 1.0 mmol/mmol) than in the controls (63 +/- 13 min and 2.9 +/- 1.1 mmol/mmol; P <0.0001 and <0.001, respectively). Multiple stepwise regression analysis demonstrated the lag time (odds ratio, 1.96; 95% confidence interval, 1.34-2.87; P <0.0001) and concentration of vitamin E in LDL (odds ratio, 1.65; 95% confidence interval, 1.16-2.33; P <0.005) as independent determinants of CAD. Significant inverse Spearman rank correlations were found between lag time (r = -0.285; P <0.001) or concentration of vitamin E in LDL (r = -0.197; P <0.002) and severity of CAD. Lag times were not significantly correlated with serum C-reactive protein or ferritin. CONCLUSIONS: Our data suggest that a short LDL oxidation lag time and a low concentration of vitamin E in LDL might be independent coronary risk factors for stable CAD in Iranian people.

Apolipoprotein B as the best predictor of coronary artery disease in Iranian normolipidemic patients.

OBJECTIVES: A relatively high proportion of Iranian patients with coronary artery disease (CAD) have normal levels of traditional lipid risk factors and show early onset of CAD. In this study we examined the roles of apolipoprotein B (apoB), apolipoprotein AI (apoAI) and lipoprotein (a) [LP(a)] in predicting coronary heart disease in normolipidemic patients and those with premature CAD (age < or = 50). DESIGN AND METHODS: Serum levels of apoB, apoAI, and LP(a) were determined in a total of 567 Iranian patients who were candidates for coronary angiography. A subgroup of 142 patients (93 males, 49 females) with normal levels of classical lipid risk factors, and a subgroup of patients (130 males, 71 females) with age below 50 years were separately assessed for coronary risk factors. RESULTS: ApoB concentrations were significantly higher in patients with CAD (CAD+) relative to patients without CAD (CAD-) in the two subgroups. Multiple logistic regression after controlling for age and others risk factors showed apoB as the best determinant of CAD in the normolipidemic subgroup (OR, 4.3, p < 0.001) and in the men aged < or = 50 (OR, 5.7, p < 0.001). ApoB was the best predictor of CAD in a subgroup of very young patients (age < or = 40, n = 77, OR, 8.6, p < 0.009). There was a significant correlation between severity of atherosclerosis and serum apoB concentration in the normolipidemic subgroup (r = 0.22, p < 0.008). CONCLUSIONS: Our data indicate that serum concentration of apoB is the best discriminating factor to predict the presence or absence of atherosclerosis in Iranian normolipidemic individuals and young patients undergoing coronary angiography.