Sperm DNA fragmentation in couples with unexplained recurrent spontaneous abortions.

The aim of the present study was to evaluate the degree of sperm DNA fragmentation in couples with idiopathic recurrent spontaneous abortion (RSA) and in those with no history of infertility or abortion. In this cohort study, 30 couples with RSA and 30 fertile couples as control group completed the demographic data questionnaires, and their semen samples were analysed according to World Health Organization (WHO) standards (September 2009-March 2010) for evaluation of sperm DNA fragmentation, using sperm chromatin dispersion (SCD) technique. The percentage of morphologically normal sperm was significantly lower in RSA patients compared with control group (51.50 ± 11.60 versus 58.00 ± 9.05, P = 0.019), but not in other parameters. Additionally, the level of abnormal DNA fragmentation in the RSA group was significantly higher than in the control group (43.3% versus 16.7%, P = 0.024). Our results indicated a negative correlation between the number of sperm with progressive motility and DNA fragmentation (r = -0.613; P < 0.001). The sperm from men with a history of RSA had a higher incidence of DNA fragmentation and poor motility than those of the control group, indicating a possible relationship between idiopathic RSA and DNA fragmentation.

Epidemiological characteristics of fatal traffic accidents in Fars province, Iran: a community-based survey.

OBJECTIVES: To determine the epidemiological characteristics of fatal traffic accidents in Fars province, Iran. STUDY DESIGN: This cross-sectional study included 3642 traffic accident deaths in Fars province, Iran between November 2009 and November 2011. The data source was the Fars Forensic Medicine Registry, which covers the entire province. According to Iranian law, all deaths resulting from injuries or accidents must be investigated to determine the exact cause of death by autopsy. All such deaths are referred to forensic medicine centres in each city, and all data are sent to the main centre in Shiraz, the capital city of Fars province. RESULTS: Males accounted for 78.3% of the decedents (sex ratio of almost 3.6:1), and the mean ± standard deviation age of all decedents was 32.2 ± 20.3 years. Autopsy reports indicated that head trauma was the most common cause of death. Most collisions were vehicle-vehicle crashes (52.3%), with cars and motorcycles being the most prevalent modes of transport (39.6% and 24.6%, respectively). Fatal accidents were most common during the summer. Most fatal injuries (61.4%) occurred on outer-city roads and 27.4% occurred on inner-city roads. Significant associations were found between decedent's status (car driver, motorcycle driver or passenger, pedestrian or passenger) and interval between injury and death, light conditions at the scene of the accident, place of death, site of injury and cause of death. CONCLUSION: Although the clinical management of trauma patients has improved in Iran, coordination between trauma system organizations is required to decrease the burden of injuries.

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

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

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

BACKGROUND: Depression is considered as one of the main psychological disorders associated with infertility. Depression may play a significant role in the life of infertile individuals, their infertility treatment follow-up and in their hopefulness for the future; it may also influence the intensity and continuousness of the mutual relationship of the affected couple. AIMS: This study was done to determine the depression rate and make a comparison between infertile and fertile couples with respect to the same. SETTING AND DESIGN: The depression rate was evaluated between two groups--infertile couples (case group) and fertile couples (control group). MATERIALS AND METHODS: Ninety-one infertile couples (cases) and 9l fertile ones (controls) were randomly enrolled in our study. Beck depression inventory (BDI) and demographic information were provided. STATISTICAL ANALYSIS: We used Chi-square, t-test; and one-way Analysis of Variance (ANOVA) was performed to find out significant difference between infertility duration in various couples and its effect on the score of depression. RESULTS: The BDI mean difference between infertile and fertile couples was significant (P=0.015). It was significantly more among couples with infertility from 1-3 years' duration compared to those with infertility of 1-year duration or less. CONCLUSION: Regarding the high rate of depression among infertile couples, it seems necessary to pay more attention to infertility centers that offer psychological and psychiatric services.

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

BACKGROUND: Oral Lichen planus (OLP) is a chronic lesion of the oral mucosa with unknown origin. Basement membrane changes are common in OLP and may be mediated by proteases such as matrix metalloproteinase (MMPs) and mast cell chymase. The aim of our study was to evaluate the level of serum MMP-3 in OLP com-pared to normal individuals and assess its clinical significance. METHODS: Thirty four serum samples from patients diagnosed with OLP (12 males, 22 females, age: 42.2±10.8 years) and 34 serum samples from healthy control subjects (11 males, 23 females, age: 42.5±13.3 years) were collected and MMP-3 concentration was measured by ELISA. RESULTS: The serum MMP-3 level in OLP patients was higher (21.64±24.31 ng/ml) compared with healthy con-trols (16.52±23.63 ng/ml), but showed no statistically significant difference. A statistically significant difference was demonstrated between the two types of OLP, being more pronounced in the erosive/atrophic form 6). CONCLUSION: The different clinical appearances of OLP are associated with significant differences in MMP-3 serum level.

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

BACKGROUND: Proton pump inhibitors (PPIs) decrease the rate of rebleeding following endoscopic hemostatic therapy in patients with bleeding peptic ulcers. This study compares the efficacy of oral omeprazole vs intravenous pantoprazole in decrease of rebleeding of peptic ulcer patients. METHODS: One hundred and six patients with high risk peptic ulcer were randomized to receive either oral omeprazole (80 mg BID for 3 days) or IV pantoprazole (80 mg bolus and 8 mg/hour infusion for 3 days) followed by omeprazole (20 mg each day for 30 days). All patients underwent upper endoscopy and endoscopic therapy within 24 hours. RESULTS: Seventeen patients were excluded from the study. Forty four patients were randomly allocated into omeprazole group and 41 patients to IV pantoprazole group. Both groups were similar for factors affecting the outcome. Bleeding reoccurred in five patients of omeprazole group and four patients in pantoprazole group (11.4% vs 9.8 %). The mean hospital stay and blood transfusion were not different in both groups. CONCLUSION: Oral omeprazole and IV pantoprazole had equal effects on prevention of rebleeding after endoscopic therapy in patients with high risk bleeding peptic ulcers.

The prevalence of labyrinthine fistula in chronic otitis media surgery in shiraz, southern iran.

BACKGROUND: The incidence of fistulas found during the surgery for chronic otitis media with cholesteatoma has been reported in a wide range in different geographical areas. This study aims to find the prevalence of labyrinthine fistula in the south of Iran. METHODS: A prospective cross sectional study of 787 (504 ears belong to 462 patients) consecutive tympanoplasty with or without mastoidectomy for chronic otitis media was performed. Data on preoperative clinical and preoperative and postoperative hearing status and intraoperative findings were analyzed. RESULTS: A labyrinthine fistula was found at surgery in 24 (4.7%) ears of the total 504 ears belonging to 462 patients undergoing surgery for chronic otitis media. Location of the fistula was the lateral semicircular canal in 23, posterior semicircular canal in 1 and promontory in 1 subject. There was a statistically significant difference in preoperative and postoperative AC threshold in 500-3000 Hz frequency and ABG 500-3000 Hz, but there was no statistically significant difference in the other variables. CONCLUSION: Regarding postoperative hearing outcome in the labyrinthine fistula surgery, it seems that there is no universal method of reporting of hearing results. Past hearing evaluation methods in the literature have been often poorly comparable, based on different methodology.

Prevalence of breast cancer in a defined population of iran.

BACKGROUND: Prevalence of breast cancer in Asian developing countries is much lower than western developed countries. The main aim of this study was to measure breast cancer prevalence in a defined population of Iran. METHODS: A total of 25201 women who were under coverage of "Imam Khomeini Relief Foundation (IKRF)", which is an organization for delivering supportive social and cultural services to the deprived and poor subgroups of the society, were involved in the study. The study was conducted during years 2007 and 2008. All subjects were interviewed for their socio-demographic features and underwent precise clinical and para-clinical breast examination. RESULTS: Mean age was 47 years with standard deviation 10 ranging from 11 to 88 years. Subjects were from deprived subgroups of the community; were mainly illiterate or had primary school education (86%) and majority of them (93%) had their first full-term pregnancy at age less than 26 years and also were multiparous. With confirmed diagnosis by breast biopsy, breast cancer prevalence was 0.15% (95%CI; 0.10-0.20). CONCLUSION: Compared with developed countries, Asian developing countries have been at a lower risk of breast cancer development. It is seen that more deprived subgroups are at much lower risk. The more industrialized life is accompanied with more hazards.

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

BACKGROUND: Several recent publications have shown that the current indications for tonsillectomy and/or adenoidectomy (T&A) in children vary considerably between and even within countries. The objective of our study is to present statistically valid information to surgeons and pediatricians, primary care physicians, and family physicians as key referral channels to the operation, whether there is consensus between pediatricians and otolaryngologists regarding the appropriateness of T&A. METHODS: Six academic pediatricians and six otolaryngologists participated in the study. After otolaryngologists visited 200 patients, the cases were referred to a pediatrician who also visited the patients independently on the same day pre-operatively. They ranked the appropriateness of T&A on a numerical Likert scale from 0 (never indicated) to 9 (always indicated) in a questionnaire. RESULTS: Overall, 200 (102 boys and 98 girls) children with a mean age of 6.1+/-5.6 were enrolled in this study. Otolaryngologists and Pediatricians had agreed about the history of tonsillitis attacks in the previous 6 months and previous year. The patients provided them with the same history. The agreement between otolaryngologists and pediatrician's views about T&A was poor. CONCLUSIONS: This study can serve as an initial warning in developing a national community-based working group to prepare a transparent local guideline regarding T&A indications. More attention should focused the role of pediatricians, primary care physicians, and family physicians for more follow up and determining which patients will eventually need T&A.

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

BACKGROUND: In the era of pediatric otolaryngology, a number of different methods have been used for the diagnosis of otitis media with effusion (OME). Although there are divers articles within the filed of assessment of the accuracy of diagnostic methods of OME, surprisingly there are very few data published and a small number of researches explaining the accuracy of Carhart notch (CN) for diagnosis of OME cases and comparing the CN with abnormal tympanic membrane findings in binocular microtympanoscopy. METHODS: Audiometric parameters studied in 89 children (178 ears) suffering from chronic otitis media with effusion. Significant CN was defined as a minimum depression of 10 dB in comparison of the rest of thresholds, at any frequency from 500 to 4000 Hz. Intra-operative microscopic otoscopic findings and the type of middle ear fluid were documented in a specially formatted questionnaire. RESULTS: The incidence of CN was 44.94% (80 ears) and that of significant CN was 25.28% (45 ears). The correlation between abnormal tympanic membrane findings and significant CN was significant and the association between CN and middle ear effusion (MEE) was not statistically significant. CONCLUSIONS: Significant CN is a sensitive diagnostic tool for detection of MEE but not specific. The diagnosis of OME in children requires a combinational diagnostic methods including tympanometry and audiometric variables especially CN.

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

BACKGROUND: The need for pathologic examination of all tonsillectomy and/or adenoidectomy (T&A) specimens is controversial. Microscopic pathologic examination of these specimens is costly, but neglecting this step may miss diagnoses of significant diseases, especially malignancies. This study was designed to determine the rate of unexpected malignancies among patients who underwent T&A. METHODS: All patients who underwent T&A at Shiraz University of Medical Sciences between February 2004 and February 2008 were included in a prospective study. Gross and microscopic pathologic examinations were done on all the specimens. The charts of the patients with significant pathological finding were reviewed. Information about pre-operative signs, symptoms, and risk factors were used to verify unexpected pathologic findings. RESULTS: A total of 5058 patients were included. The age distribution was 10 months to 92 years (mean 14.0 years). There were 2498 males (49.4) and 2560 females (50.6%). Significant pathological findings were detected in 54 patients (1%). One unexpected malignancy (0.019%) was found in an adult patient. No unexpected malignancies were found in pediatric patients. CONCLUSIONS: All T&A specimens in the adult population should be sent for microscopic pathological examination. Also specimens of nonroutine T&A in children (with positive findings in the medical history or on physical examination) should be sent for microscopic pathological examination. In children without positive findings in their history or on physical examination, gross pathological evaluation of routine T&A specimens by a pathologist is sufficient.

Current substance use in patients with gastric cancer in Southern Iran.

BACKGROUND: Psychiatric disorders may affect patients suffering from cancer and substance use disorders. OBJECTIVE: This study was undertaken to evaluate the prevalence of tobacco and opioid use in patients with gastric cancer in Shiraz, Fars Province and Southern Iran. MATERIALS AND METHODS: In a hospital survey of 177 gastric cancer patients aged 24 years and more, a semistructured-interview was performed based on SDM-IV criteria during the year 2003. RESULTS: The mean age of the patients was 58.13 (SD = 14.03) years. Among the subjects, 50.9% (90) were tobacco dependent (61.5% men and 29.4% women, P < 0.001), while 10 (5.7%) were opioid-dependent (7.3% men and 1.9% women, P = 0.16). Tobacco and opioid-dependency were not significantly related to age groups, economical or occupational status. Mean ages of tobacco and opioid-dependants were not significantly different from nondependants. CONCLUSIONS: Tobacco and opioid dependency were common problems among gastric cancer patients. This report provides useful information for health planning. Men were at greater risk than women. Treatment programs should focus on all age-groups, all occupations and all income-levels.