Rate of the incidence of hospital-acquired infections in Iran based on the data of the national nosocomial infections surveillance.

Hospital-acquired infections (HAIs) lead to increased length of hospital stay, inappropriate use of broad-spectrum antibiotics and multiple antibiotic resistance. This study aimed to investigate the rate of HAIs in Iran. In this multi-centre study, the rate of HAIs was calculated based on the data collected through Iranian nosocomial infections surveillance for patients with HAIs, as well as through hospital statistics and information systems on hospital-related variables. Data were analysed using Stata software; in addition, ArcGIS was used for plotting the geographical distribution of HAIs by different provinces. The mean age of the 107 669 patients affected by HAIs was 52 ± 26.71 years. Just over half (51.55%) of the patients were male. The overall rate of HAIs was 26.57 per 1000 patients and 7.41 per 1000 patient-days. The most common HAIs were urinary tract infections (26.83%; 1.99 per 1000 patient-days), ventilator-associated events (20.28%; 1.5 per 1000 patient-days), surgical-site infections (19.73%; 1.45 per 1000 patient-days) and bloodstream infections (13.51%; 1 per 1000 patient-days), respectively. The highest rate of HAIs was observed in intensive care units. Device, catheter and ventilator-associated infections accounted for 38.72%, 18.79% and 16% of all HAIs, respectively. Based on the results, HAIs are common in intensive care units, and urinary tract infections and device-related infections are more prevalent in Iran. To reduce HAIs it is recommended to implement appropriate policies and interventions, train staff about the use of devices, and prepare and update protocols and guidelines for improving the quality of care.

Thyroid dysfunction in patients with impaired glucose metabolism: 11 year follow up from the Tehran Thyroid Study.

OBJECTIVES: This study aimed to assess the prevalence and incidence and predictive factors of thyroid disorders (TD) in patients with impaired glucose metabolism. METHODS: Prevalence of TD was calculated in patients with impaired glucose metabolism compared to healthy controls, aged over 30 years in phase 1 of the Tehran Thyroid Study (TTS). Follow up assessments were conducted every 3 yrs, after which incidence of TD was calculated and its correlations with age, sex, smoking, blood pressure, body mass index (BMI), thyroid peroxidase antibody (TPOAb), thyrotropin (TSH), insulin resistance index, triglycerides and cholesterol were assessed. RESULTS: Incidence of TD among 435 diabetics, 286 prediabetics, and 989 healthy controls at baseline was 14, 18, and 21 per 1000 patients per year, respectively, being significantly lower in diabetics than that in healthy controls, a difference however that was not significant after adjusting for the variables mentioned (OR:0.64, 95% CI: 0.39-1.01). The incidence of TD in subjects with baseline serum TSH>1.94 mU/L or TPOAb≥40 IU/ml in all three groups was higher than that in patients with TSH≤1.94 mU/L or TPOAb<40 IU/ml, and remained significant after variable adjustment. Baseline TSH>1.94 mU/L was predictive of TD with 70% sensitivity and specificity. Baseline serum TSH (ROC area: 0.73, 95% CI: 0.68-0.77) had better predictive value than TPOAb (ROC area: 0.65, 95% CI: 0.61-0.69) for developing TD. CONCLUSION: Incidence of TD in type 2 diabetics or prediabetics is not higher than healthy controls. It is however necessary to conduct thyroid tests in patients with TPOAb≥40 IU/ml or TSH>1.94 mU/L.

Incidence of acute myocardial infarction in Islamic Republic of Iran: a study using national registry data in 2012.

Population-based data on myocardial infarction rates in the Islamic Republic of Iran have not been reported on a national or provincial scale. In a cross-sectional study, data were collected on 20 750 new cases of myocardial infarction (ICD10 codes I21-22) admitted to hospitals and registered by the Iranian Myocardial Infarction Registry in 2012. The crude and age-adjusted incidence for the 31 provinces and the whole country were directly calculated per 100 000 people using the WHO standard population. Overall, males comprised 72.4% of cases and had a significantly lower mean age at incidence than women [59.6 (SD 13.3) years versus 65.4 (SD 12.6) years]. The male:female incidence ratio was 2.63. The age-standardized myocardial infarction incidence rate was 73.3 per 100 000 in the whole country (95% CI: 72.3%-74.3%) and varied significantly from 24.5 to 152.5 per 100 000 across the 31 provinces. The study provides baseline data for monitoring and managing cardiovascular diseases in the country.

Does metabolic syndrome or its components differ in naturally and surgically menopausal women?

OBJECTIVES: This study aimed to compare metabolic syndrome and its components in naturally and surgically menopausal women. METHODS: This is a longitudinal study, with incident case and control groups, conducted on 446 women participants of the Tehran Lipid and Glucose Study, who experienced surgical or natural menopause over a 10-year period. In both groups, data collection was conducted using questionnaires including information on demographic, reproductive and metabolic characteristics at baseline and again after 3 years. Physical examinations and the biochemical profiles were also assessed. RESULTS: During the follow-up, metabolic syndrome was observed in 28.7% and 32.5% of the naturally menopause and surgically menopausal women, respectively. Mean fasting blood sugar and 2-h plasma glucose were significantly higher in the surgically menopause group, compared to the naturally menopause one, whereas mean systolic blood pressure was significantly higher in naturally menopausal women as compared to surgically menopause ones, after further adjustment for premenopausal status. CONCLUSIONS: Although no difference in the prevalence of metabolic syndrome in naturally menopausal women and in surgically menopausal women was found, the components of metabolic syndrome were more prevalent among those with surgical menopause.

Differences between subjects with sufficient and deficient urinary iodine in an area of iodine sufficiency.

BACKGROUND: Iran has long been recognized as a country of iodine sufficiency; however, recent studies show that the proportion of subjects with insufficient urinary iodine is gradually increasing in Tehran capital city. AIM: The aim of this study was to evaluate differences between individuals with sufficient and deficient urinary iodine in Tehran. MATERIAL AND METHODS: In this cross-sectional study, 639 Tehranian adult subjects, aged ≥ 19 yr (242 males, 397 females), were enrolled through randomized cluster sampling. A 24-h urine sample was collected for measurement of urinary iodine, sodium and creatinine concentrations using the digestion method, flame photometry and autoanalyzer assay, respectively. Salt intake was estimated and iodine content of household salt was measured by titration. RESULTS: Medians (interquartile range) of 24-h urinary iodine concentrations in subjects with sufficient and deficient urinary iodine were 163.0 (126.0-235.0) and 44.0 (26.0-67.0) µg/l, p<0.001, respectively. Salt with iodine content of >20 parts per million was consumed by 77.4 and 38.3% of subjects with sufficient and deficient urinary iodine, respectively (p<0.001). Median daily salt intake in subjects with sufficient urinary iodine was significantly higher than in those with deficient urinary iodine (8.1 vs 7.3 g, p<0.001). No significant differences in the mentioned variables were observed between males and females. Fifty and 30% of subjects with insufficient and sufficient urinary iodine had <7 yr education, respectively (p<0.001). CONCLUSIONS: Iodine content of salt, the amount of salt intake and education levels differ greatly between subjects with sufficient and deficient urinary iodine in Tehran.

Predictive power of the components of metabolic syndrome in its development: a 6.5-year follow-up in the Tehran Lipid and Glucose Study (TLGS).

BACKGROUND/OBJECTIVES: To determine which component of the metabolic syndrome (MetS) is the best predictor of its development. SUBJECTS/METHODS: In this cohort study, 2279 subjects aged 20-87 years without MetS selected from among the participants of the cross-sectional phase of the Tehran Lipid and Glucose Study (TLGS) were followed up for development of MetS. RESULTS: After a mean interval of 6.5 years, 462 and 602 new cases of MetS were diagnosed on the basis of the modified Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria, respectively. The adjusted odds ratio for development of MetS by ATP III criteria was highest for central obesity in men, 2.8 (2.2-3.7), and for triglycerides (TGs) in women, 2.8 (2.0-4.1). The adjusted odds ratio for the development of MetS by IDF criteria was highest for TGs in both men and women: odds ratio 2.8 (2.2-3.7) and 2.9 (1.9-4.3), respectively. A model that included waist circumference (WC) and TGs or WC and high-density lipoprotein (HDL) predicted MetS similar to a model that included all five MetS components. CONCLUSION: Screening for the timely prediction of the development of MetS should include measurement of WC, TGs and plasma HDL.

A systematic review of recent asthma symptom surveys in Iranian children.

Asthma is the most prevalent chronic disease in children. To quantify the national prevalence of asthma symptoms in Iranian children, we conducted a systematic review and meta-analysis. After internet and hand searching for population-based prevalence estimates published from 1998 to 2003 from 142 articles, dissertations and reports of research projects, 19 of them were selected. All the selected studies on children had been performed by the International Study of Asthma and Allergies in Childhood (ISAAC) protocol. We analyzed the data using NCSS software. In the included 19 studies, 61,067 children in different age groups had been examined by the ISAAC protocol. The lowest prevalence of asthma symptoms was 2.7% in Kerman and the highest was 35.4% in Tehran (capital of Iran). Overall prevalence of asthma symptoms at a national level was estimated as 13.14% (95% CI: 9.97-16.30%). Based on this study, the prevalence of asthma symptoms in Iran is higher than that estimated in the international reports. This information can be used to help prioritize asthma prevention and control within the range of Iranian public health concerns.

An epidemiological analysis of cancer data in an Iranian hospital during the last three decades.

Cancer is the third leading cause of death in Iranian population. Descriptive epidemiology provides a better understanding of the etiology of cancer and the development strategies. The objective of this study was to collect analysis of data and discuss certain epidemiologic features of neoplasm using data from hospital. Records of 14,540 patients diagnosed for cancer during the time period 1973-2003, who were referred to the department of radiation oncology were studied. The tumors were coded and classified according to the International Classification of Diseases 10th revision and ICD-O. SPSS version 10 was used for statistical analysis. In this study the frequency distribution of cancer patients were computed by age of diagnosis, gender, and anatomical sites. There were 8,178 male patients (56%) and 6,365 females (44%) with a male female ratio of 1.29. Mean age was 44.5?21.6 with a median of 47 years. The mean age of diagnosis for females (43.8.?.19.7) was significantly lower than that of males (45.0?23.1) (P<0.05). The ten most frequent cancer sites among patients were breast (13.6%), brain &CNS (13.6%), skin(13.5%), haemapoitic system(9.7%), lymphoid (7.1%), esophagus (7.1%), colon & rectum (4%), male genital organs (1.3%), bladder (1.3%), lung (1.2%), and stomach (1%). These accounted for 81% of all cases. It was found that 41% of women's cancers were in the breast, female genital organs compared to 7.3%in male genital organs and breast. All tumors except the breast, female genital organs, thyroid, gallbladder and kidney cancers, were more frequent in males compared to women. The frequency of patients with cancers increased with age in both sexes. Overall 53% of cases were between 40-63 years of age. For those aged 54 and below the male to female ratio was 0.99, while after this age the ratio rose to 1.61. About 16.6% of tumors occurred in children aged 15 years or younger. More than four fifths (81%) of patients with cancer of haematopoeitic system were under age of 15 years. In conclusion, the results of this study present an important epidemiological understanding of patients with tumors. It emphasizes that gender plays an important role in the frequency of primary tumors, and how much the sex ratio varies with some types of tumors. We also noted that certain tumor types show a prediction for certain decades of life in our series.

Using common clinical data improves the prediction of abnormal glucose tolerance by the new criteria of impaired fasting glucose: Tehran lipid and glucose study.

OBJECTIVE: To identify a subgroup of individuals with impaired fasting glucose (IFG) based on the new 2003 criteria that would most likely benefit from performance of oral glucose tolerance test. METHODS: A cross-sectional study was carried out in 1999-2001 in an Iranian urban population which enrolled 8766 individuals over 20 years. Fasting and 2-h plasma glucose was measured in all subjects after exclusion of diabetic subjects. Logistic regression and receiver operation characteristic (ROC) curve analysis were used to determine the independent clinical risk factors and their optimal cut-points associated with impaired glucose tolerance (IGT) and dysglycemia (IGT or diabetes). RESULTS: Application of the new criteria decreased positive likelihood ratio (LR+) of IFG for detecting IGT (from 6.68 to 3.86) or dysglycemia (from 9.90 to 4.46) but slightly improved their agreement (Kappa increased from 0.158 to 0.286 for IGT and 0.238 to 0.354 for dysglycemia). When the clinical data (age >45 years, BMI >28 kg/m(2) and systolic blood pressure >125 mm Hg) were added to the new criteria, the agreement of IFG with IGT and dysglycemia significantly improved (Kappa=0.470 and 0.574, respectively). This also increased the LR(+) to 14.5 and 17.4, respectively, for detecting IGT or dysglycemia. CONCLUSION: The new IFG definition in combination with common clinical risk factors constitutes a group that most likely predicts IGT or dysglycemia and may be a target for which preventive strategies should be considered.

Reproductive characteristics and the risk of breast cancer--a case-control study in Iran.

Breast cancer is a common malignancy for women in most parts of the world and the incidence in Iranian women is growing. The patients are relatively younger than their western counterparts. The present hospital based case-control study was designed to determine roles of reproductive factors for breast cancer among women in Iran. Conducted at a teaching hospital in Tehran, Iran, in 2004, the study covered a total of 303 cases of breast cancer and 303 healthy controls. Cases were identified through the Oncology Department of a university hospital and controls were collected from other wards or out-patient clinics at the same hospital. Control subjects were matched to patients for age. Informed consent was obtained from all cases and controls then demographic and reproductive factors were ascertained by in-person interview using a constructed questionnaire. Odds ratios and their 95% confidence intervals for breast cancer were derived using logistic regression analysis. The mean +/-SD ages of cases and controls were 48.8 +/- 9.8 and 50.2 +/- 11.1 years, respectively, (range 24-84). The final model for multiple analysis indicated that never married, post menopause, age at first live birth, number of live births, use of oral contraceptive pills, and history of chest X-rays between adolescence and 30 yrs of age, were significantly associated with breast cancer. Variables such as higher education, early age at menarche, abortion, breast feeding and its duration were not significant risk factors.

Effect of long-term continuous methimazole treatment of hyperthyroidism: comparison with radioiodine.

OBJECTIVE: To investigate the long-term effects of continuous methimazole (MMI) therapy. DESIGN AND METHODS: Five hundred and four patients over 40 years of age with diffuse toxic goiter were treated with MMI for 18 months. Within one year after discontinuation of MMI, hyperthyroidism recurred in 104 patients. They were randomized into 2 groups for continuous antithyroid and radioiodine treatment. Numbers of occurrences of thyroid dysfunction and total costs of management were assessed during 10 years of follow-up. At the end of the study, 26 patients were still on continuous MMI (group 1), and of 41 radioiodine-treated patients (group 2), 16 were euthyroid and 25 became hypothyroid. Serum thyroid and lipid profiles, bone mineral density, and echocardiography data were obtained. RESULTS: There was no significant difference in age, sex, duration of symptoms and thyroid function between the two groups. No serious complications occurred in any of the patients. The cost of treatment was lower in group 1 than in group 2. At the end of 10 years, goiter rate was greater and antithyroperoxidase antibody concentration was higher in group 1 than in group 2. Serum cholesterol and low density lipoprotein-cholesterol concentrations were increased in group 2 as compared with group 1; relative risks were 1.8 (1.12-2.95, P<0.02) and 1.6 (1.09-2.34, P<0.02) respectively. Bone mineral density and echocardiographic measurements were not different between the two groups. CONCLUSION: Long-term continuous treatment of hyperthyroidism with MMI is safe. The complications and the expense of the treatment do not exceed those of radioactive iodine therapy.

Assessing the impact of nutrition education on growth indices of Iranian nomadic children: an application of a modified beliefs, attitudes, subjective-norms and enabling-factors model.

In order to teach suitable feeding and hygiene practices to a group of randomly selected Qashqa'i tribe families with 406 children aged 0-59 months, a culturally appropriate community-based education intervention approach was used. To assess the impact of the intervention on the study group, another group of families with 405 children were randomly selected to serve as the controls. At the beginning of the intervention programme both groups of children had access to a similar diet, consisting of cereals, beans, oil, sugar, milk and yoghurt. Baseline data, age, gender, weight, height and mean arm circumference (MAC), were obtained before the intervention. Using Hubley's behavioural change model, the components of which deal with beliefs, attitudes, subjective norms and enabling factors, the research team studied the behaviour of the family members and tried to change their nutritional behaviour. This was achieved by designing a suitable education programme to be carried out for 12 months. During the programme, families were instructed to follow different methods of food preparation and cooking practices. The final data were collected 3 months after the end of the intervention programme. The results indicated that the children in the study group gained: 1.16 (sd 1.2) kg body weight, 0.033 (sd 0.05) m in height, 0.0067 (sd 0.015) m in MAC, 0.8 (sd 1) in weight-for-age Z-score, 0.97 (sd 1.7) in height-for-age Z-score and 0.28 (sd 1.8) in weight-for-height Z-score by the end of the study. The corresponding values for the control group were 0.42 (sd 1.0), 0.0167 (sd 0.047), 0.0017 (sd 0.012), 0.35 (sd 1.1), 0.56 (sd 1.5) and 0.014 (sd 1.6) respectively and the differences were statistically significant (P<0.05). These findings suggest that educational interventions involving parents and/or other family members who might play a role in the care behaviour and care resources are important in feeding the children energy- and protein-enriched, hygienic, simple and cheap foods. Such practices could improve child growth even under conditions of poverty.

Beneficiary effect of dietary soy protein on lowering plasma levels of lipid and improving kidney function in type II diabetes with nephropathy.

OBJECTIVE: Heart and renal diseases are two major problems in diabetic patients. Hyperlipidemia is one of the main risk factors of cardiovascular complications in diabetes. The type of protein consumed also affects the changes in renal blood flow, glomerular resistance and renal function in these patients. Hence, this study was undertaken to show the effect of soy protein consumption on lipid profiles and kidney function of diabetic patients with nephropathy, who attended an educational university hospital as well as a private kidney disease clinic in Tehran. SUBJECTS AND METHODS: This crossover randomized clinical trial was conducted on 14 patients who were free of any uncontrolled condition or other renal diseases. The patients were asked to follow a usual nephropathy diet (0.8 g/kg protein, 70% animal and 30% vegetable protein) for 7 weeks. After a washout period of 4 weeks consuming the prestudy diet, subjects were readmitted to repeat the same cycle with a similar diet containing 35% soy protein and 30% vegetable protein. Paired t-test, carryover effect and period effect were used for statistical analysis. RESULT: : There were 10 men and four women whose mean (s.d.) of weight was 70.6 (10.3) kg. Significant reductions were seen in total cholesterol (P<0.01), triglyceride (P<0.002) and LDL-c (P<0.04), urinary urea nitrogen and proteinuria (P<0.001) after soy vs animal protein consumption. There were no significant changes in HDL-c, LDL-c/HDL-c levels. We also saw a favorable effect on renal function. CONCLUSION: Soy inclusion in the diet can modify the risk factors of heart disease and improve kidney function in these patients.

Cardiovascular risk factors in an Iranian urban population: Tehran lipid and glucose study (phase 1).

OBJECTIVES: Coronary artery disease is becoming more prevalent in developing countries, particularly in urban areas. This study was conducted to determine the prevalence of cardiovascular risk factors among Tehran urban population. METHODS: The prevalence and distribution of high blood pressure, cigarette smoking, dyslipoproteinemia, diabetes mellitus, and obesity was determined in 15,005 subjects, aged three years and over, selected by cluster random sampling in Tehran urban district-13 between February 1999 to August 2001. Total energy intake, percent of energy derived from protein, carbohydrate, and fat were assessed in a subsidiary of 1,474 persons by means of two 24-hour dietary recalls. RESULTS: In adults, 78% of men and 80% of women presented at least one CVD risk factor. The percentage of adult women with two or more risk factors was significantly greater than the one for men. Prevalence of DM, hypertension, obesity, high TC, low HDL, high TGs, and smoking was 9.8, 20.4, 14.4, 19.3, 32, 5.3, and 22.3%, respectively. In children and adolescents, two or more CVD risk factors were found in 9% of boys and 7% of girls. Prevalence of hypertension, obesity, high TC, low HDL, and high TGs, was 12.7, 5.2, 5.1, 10.2, and 5%, respectively. The mean percentage values of energy intake derived from carbohydrate, protein, and fat were 57.8 +/- 6.9, 11.1 +/- 1.8, and 30.9 +/- 7.2, respectively. CONCLUSION: The prevalence of cardiovascular risk factors among Tehran urban population is high; particularly of high total cholesterol, low HDL cholesterol levels, and high waist to hip ratio. An effective strategy for life style modification is a cornerstone of a population approach to the cardiovascular risk factors. Moreover, these results will serve as a baseline for assessment of future trends in the risk factors studied.

Thyroid volumes in schoolchildren of Tehran: comparison with European schoolchildren.

Since the normative values of thyroid volume ultrasonography results from European schoolchildren were endorsed by the World Health Organization (WHO), few studies have addressed the limitation of the recommended references as universal normative values for thyroid volume. Our objective was to describe thyroid volume measured by ultrasonography in Tehranian schoolchildren and compare them with the WHO normative values. Cross-sectional studies were performed in 2016 schoolchildren, aged 6-15 yr, in Tehran 10 yr after distribution of iodized salt. Data were collected on age, sex, weight, height, thyroid size by palpation and ultrasonography, and urinary iodine. Age/sex and body surface area (BSA) upper limits (97th percentile) of thyroid volume were derived. The goiter prevalence was 42% by palpation, 31% grade 1 and 11% grade 2. Median urinary iodine was 21.2 microg/dl. The 97th percentiles were comparable in girls and boys of all ages. Applying the WHO thyroid volume references to the Tehranian children, they did not show any enlarged thyroid based on BSA and on age, even in 11% of children with grade 2 (visible) goiter. In the Tehranian children, the best predictors of thyroid volume were BSA, height and weight. Using linear regression, the 97th percentile of thyroid volume from Tehranian children were lower than the corresponding references from the WHO normative values. The results indicate that a thyroid volume reference based on weight alone would perform as well as the one based on BSA. In addition, until the adoption of a new applicable international reference for thyroid volume, the use of local reference in the screening of children for thyroid enlargement is recommended.