Publications by authors named "Armita Shahesmaeili"

30 Publications

  • Page 1 of 1

Proportion and reasons for loss to follow-up in a cohort study of people who inject drugs to measure HIV and HCV incidence in Kerman, Iran.

Subst Abuse Treat Prev Policy 2021 Apr 1;16(1):29. Epub 2021 Apr 1.

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Background: Understanding the reasons for loss to follow-up (LTFU) in cohort studies, especially among marginalized groups such as people who inject drugs (PWID), is needed to strengthen the rigor of efficacy trials for prevention and treatment interventions. We assessed the proportion and reasons for loss to follow-up in a recent cohort of PWID enrolled in the southeast of Iran.

Methods: Using respondent-driven sampling, we recruited 98 PWID age 18 years or older who reported injecting drugs in the past 6 months, and were negative for HIV and HCV at initial screening. Participants were followed at 6 week intervals, alternating a short six-week visit and long 12-week or quarterly visit to measure incidence of HIV and HCV. Methods to enhance retention included incentives for completing each visit, tracking people who missed the scheduled visits through their peer referral networks, engaged outreach teams to explore hotspots and residences, and photos. LTFU was defined as participants who missed their quarterly visits for two or more weeks.

Results: Mean (SD) age of participants was 39.7 years (SD 9.6). Of 98 enrolled, 50 participants (51.0%) were LTFU by missed their scheduled quarterly visits for 2 weeks or more. For those whose reasons for LTFU could be defined (46.0%, 23 of 50), main reasons were: forgetting the date of visit (43.5%, 10 of 23), being incarcerated (39.1%, 9 of 23), and moving out of the city (17.4%, 4 of 23).

Conclusion: This study highlighted the difficulty in retaining PWID in longitudinal studies. Despite having several retention strategies in place, over half of PWID were LTFU. The LTFU might be reduced by setting up more effective reminder systems, working closely with security systems, and online means to reach those who move outside the study area.
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http://dx.doi.org/10.1186/s13011-021-00368-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017615PMC
April 2021

Barriers and motivators to participation and retention in HIV/HCV cohort studies among people who inject drugs: a community consultation in Iran.

Subst Abuse Treat Prev Policy 2020 08 5;15(1):56. Epub 2020 Aug 5.

Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.

Background: The lack of robust estimates of HIV/HCV incidence among people who inject drugs (PWID) in Iran calls for well-designed prospective cohort studies. Successful recruitment and follow-up of PWID in cohort studies may require formative assessment of barriers PWID are faced with in participation and retention in cohort studies and factors they think may facilitate their engagement in such studies. Using a focus group discussion (FGD) format, we conducted a consultation with PWID in southeast Iran to recognize those barriers and motivators.

Methods: Using targeted sampling and through snowball referrals, we recruited PWID (aged≥18, injected in last 6 months) from community-based drop-in centers (DICs), homeless shelters, and through outreach efforts to participate in four FGDs (one women-only). Socio-demographic characteristics, injection behaviors and self-reported HCV/HIV testing and diagnosis history were obtained. Then, a semi-structured FGD guide was applied to explore barriers and motivators to participation and retention in cohort studies among study participants. All FGD sessions were recorded and transcribed verbatim, removing any identifying information. The content of FGDs were analyzed by thematic analysis using an inductive approach.

Results: In total, 30 individuals (10 women) participated in the study. The median age of participants was 35 (IQR 31-40), with majority (73.3%) reporting injecting drug use within the last month. Only 40.0% reported ever being tested for HCV whereas a larger proportion (63.4%) reported ever being tested for HIV. While the majority were willing to participate in cohort studies, breach of confidentiality, fear of positive test results, perceived required commitment, and marginalization were reported as barriers to participation and retention in such studies. Monetary incentive, the thought of a better life, protection from police interventions and trust between health workers and PWID were addressed as motivators of engagement in cohort studies among PWID.

Conclusions: Strategies to enhance data security and reduce stigma associated with injecting drug use along with involving peer workers in research, providing pre and post-test counselling and education and addressing the needs of more marginalized groups potentially through integrated healthcare programs and housing support are among few approaches that may help address barriers and strengthen the motivators for successful cohort studies among this population.
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http://dx.doi.org/10.1186/s13011-020-00298-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405425PMC
August 2020

Opioid agonist therapy uptake among people who inject drugs: the findings of two consecutive bio-behavioral surveillance surveys in Iran.

Harm Reduct J 2020 07 22;17(1):50. Epub 2020 Jul 22.

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran, Haftbagh Highway, Kerman, 7616913555, Iran.

Background: Opioid agonist therapy (OAT) uptake has been associated with multiple positive health outcomes among people who inject drugs (PWID). This study evaluated the pattern of OAT uptake among PWID in two consecutive national bio-behavioral surveillance surveys (2010 and 2014) in Iran.

Methods: Data were obtained from two national bio-behavioral surveillance surveys (N = 1783 and N = 2166) implemented using convenience sampling at the harm reduction facilities and street venues in 10 geographically diverse urban centers across Iran. Multivariable logistic regression models were built to determine the correlates of OAT uptake for the 2014 survey, and adjusted odds ratios (AORs) along with 95% confidence intervals (CI) were reported.

Results: The prevalence of OAT uptake decreased from 49.2% in 2010 to 45.8% in 2014 (P value = 0.033). OAT uptake varied across the studied cities ranging from 0.0 to 69.3% in the 2010 survey and 3.2 to 75.5% in the 2014 survey. Ever being married (AOR = 1.40; 95% CI 1.12, 1.75), having a history of incarceration (AOR = 1.56; 95% CI 1.16, 2.09), and human immunodeficiency virus (HIV) sero-positivity (AOR = 1.63; 95% CI 1.08, 2.50) were associated with OAT uptake. Conversely, PWID who reported using only non-opioid drugs (AOR = 0.43; 95% CI 0.26, 0.71) and those who reported concurrent use of opioid and non-opioid drugs (AOR = 0.66; 95% CI 0.51, 0.86) were less likely to uptake OAT.

Conclusions: Although OAT uptake among PWID in Iran is above the 40% threshold defined by the World Health Organization, there remain significant disparities across urban settings in Iran. Importantly, the OAT services appear to be serving high-risk PWID including those living with HIV and those with a history of incarceration. Evaluating service integration including mental health, HIV and hepatitis C virus care, and other harm reduction services may support the optimization of health outcomes associated with OAT across Iran.
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http://dx.doi.org/10.1186/s12954-020-00392-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373839PMC
July 2020

Prevalence of JC and BK viruses in Patients with Colorectal Cancer: A Systematic Review and Meta- Analysis.

Asian Pac J Cancer Prev 2020 Jun 1;21(6):1499-1509. Epub 2020 Jun 1.

HIV/STI Surveillance Research Center, and WHO Collaborating center for HIV surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Introduction: Polyomaviruses including BK virus (BKV) and JC virus (JCV) are widespread in human and have been associated with colorectal cancer (CRC) in some studies. The aim of present systematic review and meta-analysis article is to calculate the pooled prevalence of BKV and JCV in patients with CRC and assessing their association with this malignancy.

Materials And Methods: Domestic databases and Sciences Direct, PubMed, ProQuest, Web of Sciences and Scopus were searched for relevant articles up to 2nd  June 2019Two independent reviewers extracted the related data from eligible articles. The pooled prevalence and pooled odds ratio (POR) and their 95% confidence interval (95% CI) were calculated using "metaprop" and "metan" commands in Stata 14. Where I2 statistics were >50%, the random effect model was used.

Results: From 1461 relevant studies, 24 articles were eligible and included in the qualitative while 19 articles included in quantitative analysis. The pooled prevalence based on diagnostic methods varies from 29% using immunohistochemistry to 52% using nested-PCR method. The likelihood of being infected with JCV  was significantly higher in CRC patients compared to healthy (POR: 4.41, 95% CI: 2.13 - 9.13) controls, normal adjacent mucosa (POR: 2.79, 95% CI: 1.3-5.9) and colorectal adenoma (POR: 3.1, 95% CI: 1.5-6.5) but was not significant when non-CRC patients used as control group.

Conclusion: The prevalence of JCV in colorectal patients was substantially variable by different methods and targets. The significant association between JCV and CRC that was observed in the present study is not indicative of causation and should be studied more in large-scale prospective designs.
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http://dx.doi.org/10.31557/APJCP.2020.21.6.1499DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568898PMC
June 2020

One-Step Resection via Hysteroscopic Myomectomy and Prostaglandin F2α for Large Submucosal Myoma.

J Minim Invasive Gynecol 2020 May - Jun;27(4):826-831. Epub 2020 Feb 24.

Endometriosis Research Center (Drs. Vahdat and Mansouri); Iran University of Medical Sciences, Tehran, Iran , (Dr. Kashanian); Department of Radiology, School of Medicine (Dr. Mostafavi), Iran University of Medical Sciences, Tehran; Department of Gynecology (Dr. Mansouri); HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health (Mr. Mirzaei and Dr. Shahesmaeili), Kerman University of Medical Sciences, Kerman, Iran.

Study Objective: To assess the efficacy of prostaglandin F2α (PGF) in hysteroscopic myomectomy of submucous myomas.

Design: Single-blind, randomized clinical trial study.

Setting: Teaching hospital, affiliate of Iran University of Medical Sciences, Tehran, Iran.

Patients: Forty-four patients with symptomatic submucous myomas were randomly assigned to the intervention group (n = 21; 1 excluded owing to myoma not identified on pathologic examination) and the control group (n = 22).

Interventions: In the intervention group, PGF was injected into the cervix twice: before the beginning of the surgery and after the resection of the intrauterine portion of the submucous myoma. TIn the control group, the myomas were resected without the PGF injection. The same procedure was performed in the control group without the PGF injection.

Measurements And Main Results: There were no differences in the demographics, size, or type of myomas among the groups at baseline. Although the proportion of complete removal of the submucous myomas in the intervention group (PGF) was higher (20/23 myomas or 87%) than that in the control group (15/23 myomas or 65.2%), the difference was not significant (p = .1). The number of 1-step complete removal of large submucous myomas (>5 cm) in the PGF group was significantly higher than that in the control group (8/10 myomas [80%] vs 2/8 myomas [25%], p = .03). The mean duration of operative time was significantly longer in the intervention group than in the control group (p = .01). The intervention group experienced more days of postoperative bleeding than the control group (p = .001). There were no differences regarding the length of stay at the hospital or hemoglobin levels between the groups (p = .07).

Conclusion: In the current study, injection of PGF was beneficial for 1-step complete resection of large (>5 cm) submucous myomas via hysteroscopic myomectomy.
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http://dx.doi.org/10.1016/j.jmig.2019.05.026DOI Listing
February 2020

The correlation between blood oxidative stress and sialic acid content in diabetic patients with nephropathy, hypertension, and hyperlipidemia.

Diabetol Int 2020 Jan 9;11(1):19-26. Epub 2019 May 9.

2Pharmaceutics Research Center, Institute of Neuropharmacology, Faculty of Pharmacy, Kerman University of Medical Sciences, Haft Bagh-e-Alavi Highway, 7616911319 Kerman, Iran.

This clinical study was designed to find out the correlation between oxidative stress and sialic acid (SA) content of plasma and RBCs in patients with type 2 diabetes. We evaluated SA concentration and oxidative stress biomarkers in healthy subjects and diabetic patients with and without complications in a cross-sectional survey. Significant changes in oxidative stress biomarkers and RBC-SA were revealed in the diabetic patients compared to those in the healthy group. Plasma SA significantly increased with an increase in lipid peroxidation of RBCs (LPO-RBC) ( < 0.001) in the diabetic patients without complication. RBC-SA significantly decreased with an elevation in LPO-RBC ( < 0.001) in all the diabetic patients and those with nephropathy. There was no significant correlation between plasma and RBC-SA and other oxidative stress biomarkers in the diabetic subjects. In multiple logistic regression analysis, RBC-SA was independently related to LPO-RBC in all the diabetic patients and those with nephropathy. We conclude that the induction of LPO-RBC in diabetic patients and those with nephropathy may influence the SA decomposition of RBC membrane, thereby altering its functions and transporter activities. Therefore, LPO-RBC and SA levels in RBCs can be used for prediction of diabetic nephropathy, and further studies to evaluate other factors contributing to desialylation of RBC membrane are justified.
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http://dx.doi.org/10.1007/s13340-019-00395-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942093PMC
January 2020

HIV risk perception and sexual behaviors among female sex workers in Tehran, Iran.

Med J Islam Repub Iran 2019 25;33:101. Epub 2019 Sep 25.

Department of Sociology, University of Groningen, 9712 TG Groningen, Netherlands.

An adequate perception of the degree to which one is at risk of having or contracting HIV is necessary for behavioural change and the adoption of safe behaviours. There are limited data regarding HIV risk perceptions among female sex workers in Iran. This study aimed to determine the HIV risk perception status and its association with sexual behaviours among female sex workers in Tehran. A cross sectional study was conducted among 170 female sex workers in Tehran. Participants were recruited using a combination of snowball, purposeful, and convenience sampling methods. Multiple logistic regression was used to identify adjusted associations between background factors, sexual behaviours, and HIV risk perception. The analysis was conducted by the "logistf" package in the R statistical system. P-value less than .05 was considered as statistically significant. Among the participants, 122 (77%) reported high HIV risk perception. Most female sex workers with high HIV risk perception reported that they did not consistently use condoms (n=120, 98%. Female sex workers with a higher frequency of sex work (AOR=1.18, 95% CI: 1.08, 1.31), inconsistent condom use (AOR=0.15, 95% CI: 0.02, 0.66), a history of HIV testing (AOR=5.1, 95% CI: 1.2, 26.0), and low HIV knowledge (AOR=0.97, 95% CI=0.95, 0.996) were more likely to report high HIV risk perception. Most female sex workers with risky sexual behaviours had a high HIV risk perception. Effective educational programs are suggested to enable female sex workers to correctly assess their own HIV risk and change risk behaviors based on self-assessment of actual risk.
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http://dx.doi.org/10.34171/mjiri.33.101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946931PMC
September 2019

Population Size Estimation of Tramadol Misusers in Urban Population in Iran: Synthesis of Methods and Results.

Addict Health 2019 Jul;11(3):173-182

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Background: Estimating the population who use drugs is essential for planning, monitoring, and evaluation of substance use prevention and treatment. This study aims to estimate the population who misuse tramadol in urban population in Iran.

Methods: We used the wisdom of the experts (WOTE) and network scale-up (NSU) methods to calculate the population of tramadol misusers in 10 provincial capitals of Iran, in 2016. The WOTE was conducted among pharmacists in drugstores and the personnel of traditional medicinal herbs stores. They guessed the best estimation of tramadol misusers population in their cities. The NSU method was conducted among the general population and participants were questioned about ever and daily, non-medical use of tramadol during last 12 months in their network. The median of the methods was used to calculate the proportion of the adult population (15-49 years old).

Findings: The population size of tramadol misusers in studied cities was 83300 [95% uncertainty limits (UL): 47960-256220]. This corresponded to 6.6 per 1000 (95% UL: 3.88-20.30) of the 15-49-year-old population. The projected number of tramadol misusers for all 31 provincial capitals was 118290 (95% UL: 68100-363130840) and 212440 (95% UL: 122310-653410) for all urban areas. NSU also estimated the number of people who misuse tramadol on daily basis. These numbers were 52000 (95% UL: 19940-176570) for studied cities, 73840 (95% UL: 28320-250740) for all 31 provincial capital cities, and 132610 (95% UL: 50860-450310) for all urban areas in Iran.

Conclusion: This study presents information on high prevalence of tramadol misuse in urban population. We need national control measures and demand reduction programs to control tramadol misuse.
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http://dx.doi.org/10.22122/ahj.v11i3.240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6904981PMC
July 2019

Studying the effect of structured ostomy care training on quality of life and anxiety of patients with permanent ostomy.

Int Wound J 2019 Dec 16;16(6):1383-1390. Epub 2019 Aug 16.

Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran.

Patients with ostomy are faced with several physical, psychological, and social challenges and need to be prepared to overcome these challenges. Studies have shown that training plays an important role in helping patients to adapt with ostomy, live with it, and improve their psychological well-being and quality of life (QOL). Therefore, the present study aimed to determine the effect of structured ostomy care training on QOL and anxiety of the patients with permanent ostomy. In this randomised clinical trial study, 60 eligible participants were recruited from the only ostomy clinic in Kerman, Iran. They were selected using a purposive sampling method and randomly assigned to either a control group that received routine ostomy care or an intervention group that attended oral and practical training and a question and answer session by a trained ostomy nurse and received an ostomy information booklet besides their routine care. Outcome variables were anxiety and QOL in general and its physical, mental, social, and spiritual dimensions in detail. By using the anxiety subscale of Hospital Anxiety and Depression Scale (HADS) and City of Hope-quality of life [COH-QOL], data were collected before and 2 months after intervention in both groups. Data were analysed by SPSS version 19 using χ², analysis of variance (ANOVA), independent t, and paired t test and multiple regression analysis. The results showed that the intervention group had significantly lower mean scores in anxiety (P = .001) and a higher mean score in overall QOL (P = .009) compared with the control group. The most significant increase was observed for psychological, social, and physical aspects, and the least was in the spiritual aspect, all of which improved after intervention. After controlling the effects of confounding variables such as age, ostomy period, and number of children, the structured training programme still had a positive effect on QOL. Structured ostomy care training, including face-to-face education and personal practice of using ostomy equipment, along with written material provided by the ostomy nurse specialist, may lead to an increase in the overall QOL and a decrease in the perceived anxiety level in patients. This type of training is not routinely delivered to ostomy patients in our health care setting, so it is feasible to prepare surgical wards and to educate nurses to work with their patients before and after ostomy creation. Furthermore, to ease patients' religious concerns, we recommend counselling, and the support of religious leaders in the Muslim community may play a key role to adaptation regarding religious matters after ostomy surgeries and alleviate patients' concerns.
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http://dx.doi.org/10.1111/iwj.13201DOI Listing
December 2019

Amplatz versus Balloon for Tract Dilation in Ultrasonographically Guided Percutaneous Nephrolithotomy: A Randomized Clinical Trial.

Biomed Res Int 2019 3;2019:3428123. Epub 2019 Jan 3.

Department of Urology, Shahid Bahonar Hospital, Kerman University of Medical Sciences (KMU), Kerman, Iran.

Purpose: To compare balloon with Amplatz for tract dilation in totally ultrasonographically guided PCNL (UPCN).

Methods: We randomized 66 patients candidate for sonographically guided PCNL in the flank position in two study groups. In the first group, we used single step Amplatz dilation (AG) technique in which the 28- or 30-French Amplatz dilator is used for tract dilation. In the other group, we dilated the tract using balloon dilator (BG). We compared procedure time, success rate of dilation, and postoperative clinical outcomes and cost between two groups.

Results: The rate of short dilation was higher in the Amplatz group (57.6%) compared with Balloon group (36.4%) (P=0.08). When using Amplatz for lower pole access, short dilation occurred in 81% of cases compared with 44% in the BG (P=0.02). Overall operation was longer in the AG (80±21 versus 65±20 minutes P=0.02). Stone free rate was 87.9% in the AG compared with 72.7% in the BG (p=0.12). Mean cost of the surgery was 603±85 USD and 718±78 USD in the AG and BG, respectively (P=0.0001). Hemoglobin drop, transfusion rate, renal function alteration, duration of hospitalization, and complication rate based on Clavien classification were similar in both groups.

Conclusions: AG showed a higher rate of short dilation compared with BG; consequently, overall operating time was significantly longer in the AG whereas BG was significantly more expensive than AG. Bleeding and other complications were similar in two groups. We observed an advantage for balloon dilation over Amplatz when approaching the lower pole calyxes.
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http://dx.doi.org/10.1155/2019/3428123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335701PMC
May 2019

Comparison of Lipid Ratios to Identify Metabolic Syndrome.

Arch Iran Med 2018 12 1;21(12):572-577. Epub 2018 Dec 1.

Endorinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran.

Background: The objective of this study was to compare various lipid ratios for detection of metabolic syndrome (MetS) in the Iranian general population.

Methods: This cross-sectional study involved 5677 subjects aged ≥18 years from the general population in Kerman, Iran. Associations between lipid ratio quartiles and MetS were analyzed using logistic regression models. The areas under receiver operating characteristic (ROC) was calculated to determine the accuracy of lipid ratios in predicting MetS.

Results: The adjusted chance of having MetS across quartiles of all lipid ratios had an increasing significant pattern (P < 0.0001). The area under the curves of triglyceride/high-density-lipoprotein-cholesterol (TG/HDL-C) ratio was 0.85 (95% CI = 0.84-0.87) in men and 0.85 (95% CI = 0.84-0.86) in women, of total cholesterol (TC)/HDL-C ratio was 0.79 (95% CI = 0.77-0.81) in men and 0.79 (95% CI = 0.77-0.81) in women and of low-density-lipoprotein cholesterol (LDL-C)/HDL-C ratio was 0.73 (95% CI = 0.71-0.75) in men and 0.74 (95% CI = 0.72-0.76) in women.

Conclusion: Our results indicate that the TG/HDL-C Ratio is a better marker than the LDL-C/HDL-C ratio and the TC/HDL-C ratio for identifying MetS in the Iranian population and could be used in clinical practice.
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December 2018

Transition from First Drug Use to Regular Injection among People Who Inject Drugs in Iran.

Addict Health 2018 Jan;10(1):32-40

Assistant Professor, Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Background: The study aimed to evaluate the interval between first drug use and regular injection and factors associated with transition from first injection into premature regular injection among people who inject drugs (PWIDs).

Methods: In a multicenter cross-sectional study, we recruited 400 PWIDs using snowball sampling. Age of first drug use, age of initiation of regular injection, and demographic and behavioral data were collected using face to face interview. Premature transition to regular injection was defined as initiation of regular injection within the five years of first injection. Data were analyzed using bivariate and multivariate logistic regression survey analysis.

Findings: The mean age of first drug use and age of initiation of regular injection was 29.87 ± 6.54 years, respectively. Having history of sexual abuse in childhood [adjusted odds ratio (AOR) = 3.1], history of imprisonment (AOR = 3.4), use of heroin as the first drug (AOR = 4.3), and doing the first injection at friends' houses (AOR = 2.2) or in ruins (AOR = 2.2) significantly increased the chance of premature transition to regular injection, while being a female decreased the chance of premature transition to regular injection (AOR = 0.4). Compared to curiosity, being friend with a drug user (AOR = 0.4), having withdrawal symptoms (AOR = 0.2), and low cost of injection (AOR = 0.3) at the first occasion of drug injection reduced the chance of premature transition to regular injection.

Conclusion: New interventions to prevent injection initiation among drug users are needed and should be integrated in harm reduction programs.
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http://dx.doi.org/10.22122/ahj.v10i1.458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312558PMC
January 2018

Effect of Aerobic Exercises on Serum Levels of Apolipoprotein A1 and Apolipoprotein B, and Their Ratio in Patients with Chronic Obstructive Pulmonary Disease.

Tanaffos 2018 Feb;17(2):82-89

Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Cardiovascular disease is one of the most common disorders associated with chronic obstructive pulmonary disease (COPD). There are few studies on the effects of physical exercises, especially aerobic exercises, on serum levels of apolipoprotein A1 and apolipoprotein B in patients with COPD. The current study aimed at determining the effect of aerobic exercises on serum levels of apolipoprotein A1 and B and apo-A1/apo-B ratio.

Materials And Methods: In the current randomized, controlled, clinical trial, with a pretest posttest control group design, 22 males with COPD were randomly assigned to the aerobic exercise and control groups. The aerobic exercise program was performed within two months based on three 30-40-minute sessions per week. Serum levels were measured and evaluated before and after aerobic exercises. Data were analyzed using the paired samples test.

Results: In the aerobic exercise group, the mean of Apo A1 and Apo B after the intervention (169.36±5.42 and 93.63±5.24 mg/dL, respectively) was significantly higher than that of before the intervention (146±6.09 and 83.27±4.44 mg/dL, respectively) (P-value=0.001). However, apoA1/Apo B ratio did not significantly change after the intervention compared with that of before the intervention (1.85±0.10 vs. 1.80±0.13) (P >0.05). There was no significant change in the mean Apo A1 and Apo B levels and Apo A1/Apo B ratio after the intervention in the control group.

Conclusion: Regular aerobic physical exercises are effective in increasing the serum level of Apo A1 in patients with COPD. Due to the proven protective role of Apo A1 in patients with COPD, this biomarker can improve respiratory efficacy in such patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320561PMC
February 2018

Dual Unsafe Injection and Sexual Behaviors for HIV Infection Among People Who Inject Drugs in Iran.

AIDS Behav 2019 Jun;23(6):1594-1603

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

We used two national surveys (2010: N = 1597; 2013: N = 1057) of people who inject drugs (PWID) in past-month to assess the prevalence and population size of PWID with either safe or unsafe injection and sex behaviors, overall and by HIV status. In 2013, only 27.0% (vs. 32.3% in 2010) had safe injection and sex, 24.6% (vs. 23.3% in 2010) had unsafe injection and sex, 26.4% (vs. 26.5% in 2010) had only unsafe injection, and 22.0% (vs. 18.0% in 2010) had unsafe sex only. Among HIV-positive PWID in 2013, only 22.1% (~ 2200 persons) had safe injection and sex, 14.2% (~ 1400 persons) had unsafe injection and sex, 53.1% (~ 5200 persons) had unsafe injection, and 10.6% had unsafe sex (~ 1100 persons). Among HIV-negative PWID in 2013, only 27.5% (~ 22,200 persons) had safe injection and sex, 25.9% (~ 20,900 PWID) had unsafe injection and sex, 23.2% (~ 18,700 persons) had unsafe injection, and 23.3% (~ 18,800 persons) had unsafe sex. HIV-positive and -negative PWID in Iran continue to be at risk of HIV acquisition or transmission which calls for targeted preventions services.
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http://dx.doi.org/10.1007/s10461-018-2345-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527484PMC
June 2019

Cancer Incidence in Kerman Province, Southeast of Iran: Report of an ongoing Population-Based Cancer Registry, 2014

Asian Pac J Cancer Prev 2018 Jun 25;19(6):1533-1541. Epub 2018 Jun 25.

Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran. Email:

Introduction: The epidemiology of common cancers in Kerman province, southeast of Iran, was assessed based upon results of the Kerman Population-Based Cancer Registry Program (KPBCR). Methods: in this retrospective study, all patients diagnosed with primary cancers and registered with the KPBCR were included. New cancer cases registered from 2014 were identified from pathological labs, medical reports of 48 health facilities providing cancer diagnosis or treatment services and the national death registry program. Data for patients who were referred to neighboring provinces to access health services were also collected from national referral registries. Results from autopsies was additionally extracted from regional forensic and legal medicine centers and added to the registry periodically. Age standardized incidence rates (ASRs) per 100,000 person-years for all cancers were computed, using direct-standardization and CanReg methodology. Mortality to incidence (M:I) ratios and microscopically verified (MV) proportions were calculated as quality measures. Results: A total of 2,838 cases of cancer were registered in Kerman province, 2014. Of these 45. 6% involved women (n=1,293). Individuals aged 60-64 years represented the largest proportion (11.6%) of the total cancer prevalence, followed by those aged 55-59 years (10.86%) and 65-69 years (8.99%). The ASRs for all cancers were 155.1 and 118.90 per 100,000, in men and women, respectively. In women, breast (ASR: 26.4), skin (ASR: 13.0), thyroid (ASR: 9.2), leukemia (ASR: 8.0) and colorectal (ASR: 7.70) were the most common cancers. In men, bladder (ASR: 24.70), skin (ASR: 16.80), lung (ASR: 14.6), leukemia (ASR: 14.50), and stomach (ASR: 10.8) were found to be the most frequent. Conclusion: This study provided latest evidence on epidemiology of cancer in the southeast of Iran that could be used to empower prevention and control interventions in a developing country.
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http://dx.doi.org/10.22034/APJCP.2018.19.6.1533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6103577PMC
June 2018

Syringe Sharing in Drug Injecting Dyads: A Cross-Classified Multilevel Analysis of Social Networks.

AIDS Behav 2018 Jul;22(Suppl 1):10-18

Safety Promotion and Injury Prevention Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

We examined the association of dyadic-level factors with syringe sharing among people who inject drugs (PWID) in Kerman, Iran. In a cross-sectional study, we collected data on 329 drug-injecting dyads by individual face-to-face interviews. An injecting dyad was defined as 2 PWID who knew each other and injected drugs together during the last 6 months. If they reported at least 1 occasion of syringe sharing, the dyad was considered high-risk. Dyadic-level factors associated with syringe sharing were assessed using cross-classified multilevel logistic regression. The rate of syringe sharing was significantly higher for dyads who were more intimate (adjusted odds ratio [AOR] 4.5, CI 95%, 2.3-8.6), who had instrumental support (AOR 2.1, 95% CI 1.1-4.5), and who pooled money for drugs (AOR 4.1, 95% CI 2.0-8.3). The rate was lower in same-sex dyads (AOR 0.4, 95% CI 0.2-0.9) and in dyads who shared health information (AOR 0.5, 95% CI 0.2-0.9). Findings highlight close-peer influences on syringe-sharing behavior.
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http://dx.doi.org/10.1007/s10461-018-2144-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6237650PMC
July 2018

Symptom-Based Versus Laboratory-Based Diagnosis of Five Sexually Transmitted Infections in Female Sex Workers in Iran.

AIDS Behav 2018 Jul;22(Suppl 1):19-25

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Among 1337 Iranian adult female sex workers in 2015, we assessed the diagnostic value of 4 self-reported sexually transmitted infection (STIs) symptoms for detecting laboratory-confirmed gonorrhea, chlamydia, trichomoniasis, human papillomavirus (HPV), and syphilis. While 37.7% reported vaginal discharge (VD), 25.9% reported pain or burning (P/B), 3.0% reported genital ulcers (GU), and 1.4% reported genital warts (GW), the prevalence of laboratory-confirmed syphilis, gonorrhea, chlamydia, trichomoniasis, and HPV was 0.4, 1.3, 6.0, 11.9, and 41.9%, respectively. The sensitivity of VD was 40.3% for detecting tricomoniasis, 37.5% for chlamydia, and 37.5% for gonorrhea. The sensitivity of P/B ranged from 12.5% for gonorrhea to 25.2% for trichomoniasis. The sensitivity of GU and GW was very low for 5 STIs. The sensitivity of all symptoms combined was also lower than 50%. Among asymptomatic participants, 41.2% tested positive for HPV, 11.8% for trichomoniasis, and less than 6.6% for other STIs. Symptom-based case management and surveillance of STIs can lead to misclassification of a large proportion of cases.
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http://dx.doi.org/10.1007/s10461-018-2130-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226376PMC
July 2018

Relationship between a network's indicators and basic factors with high-risk behavior of injection among injecting drug users (IDU) via the multiple membership multilevel model.

Electron Physician 2017 Sep 25;9(9):5318-5324. Epub 2017 Sep 25.

Ph.D. of Biostatistics, Assistant Professor, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Background: Among various methods and types of drug abuse, injection receives a great deal of importance because of its related dangerous behavior and health consequences. It seemed that some of the network's indicators affect dangerous behavior of injection.

Objective: To determine the relationship between a network's indicators and basic factors with high-risk behavior of injection among injecting drug users (IDU) via the multiple memberships multilevel model.

Methods: In this cross-sectional study, the data related to 147 IDUs in Kerman province, who were interviewed from October 2013 through March 2014, were used, and these addicts were chosen for interview from specific resorts used for common injection. In this study, for analyzing data, multiple membership multilevel model and MLwiN 2.02 software were used.

Results: In this study, the mean age of people, who were mostly men, was 37.2±9.02. Based on the result, it becomes obvious that variables of in-degree with OR=1.49 (p=0.006) and the whole number of people related to the person with OR=1.18 (p=0.003) influences the high-risk behavior of injection. Also, none of the demographic variables influenced the high-risk behavior of injection.

Conclusion: Totally based on the results of this study, one can find a suitable method in the social network of IDUs in order to create essential strategies, reducing the risk throughout the country. In addition, in minimum time with fewer expenses, aggravation of dangerous behavior especially high-risk behavior of injection can be prevented.
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http://dx.doi.org/10.19082/5318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633232PMC
September 2017

An Investigation of the Risk Factors of Osteoporosis and the Correlation between Opium Consumption and Osteoporosis in Adults.

Addict Health 2017 ;9(4):214-221

Associate Professor, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.

Background: Osteoporosis and osteopenia are the most common metabolic bone diseases making the patients vulnerable to bone fragility and fracture. In this study, the association of opium consumption and osteoporosis adjusted for other risk factors was studied.

Methods: In this cross-sectional study, 619 cases including 73 men and 546 women referred to densitometry center in Kerman, Iran, were studied. Demographic information, history of opium consumption, medications, and other risk factors were collected using a structured questionnaire.

Findings: In a univariate analysis, opium consumption, aging, and having a body mass index (BMI) lower than 24 accompanied an increased chance of osteoporosis, while taking physical exercises on a daily basis reduces the chance of osteoporosis. Through multivariable analysis, the two variables of age group and BMI group turned out to be of significance; that is, the chance of osteoporosis or osteopenia in the age group of higher than 60 years and 45-60 years being placed in one of the levels of osteoporosis or osteopenia was 4.9 and 3.1 times higher than the age groups lower than 45 years, respectively, after being adjusted to the other variables.

Conclusion: Considering the results of this study, though the risk of bone density reduction in the individuals consuming opium was higher, due to the disparity between opium consumption in the two sexes, the difference was not significant between the two groups, and it is proposed that studies on larger samples and in the both sexes be conducted to determine the impacts of opium on the bone density.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294486PMC
January 2017

Awareness of and Knowledge About STIs Among Nonmedical Students in Iran.

Int Perspect Sex Reprod Health 2017 Jul 7;43(1):21-28. Epub 2017 Jul 7.

HIV/STI Surveillance Research Center.

Context: Evidence on STI knowledge among Iranian nonmedical university students is limited. Information is needed to inform research and policies to improve the sexual health of university students in Iran.

Methods: A convenience sample of 742 male and female undergraduate and graduate students was recruited from five nonmedical public and private universities in Iran in 2014. Respondents' awareness of and knowledge about STIs were assessed using a validated questionnaire. Chi-square tests, student t tests and one-way analysis of variance were used to compare the percentage of respondents giving correct responses across subgroups of students.

Results: Half of the respondents had ever heard of STIs, but most could not correctly identify STIs in a list of diseases. A total of 49%, 42% and 9% of the respondents had low, moderate and high STI knowledge scores, respectively. Respondents reported online sources (62%) and friends (32%) as their main sources of information about STIs, and those who were older, ever-married or more educated were more knowledgeable than other respondents.

Conclusions: Given that the Internet was students' main source of information, increasing the accessibility and visibility of credible Internet sites about sexual health is warranted. Also, key individuals in students' networks (e.g., parents, teachers, peers) should be equipped with required training and knowledge on STI-related topics and be actively involved in sexual health education efforts.
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http://dx.doi.org/10.1363/43e3217DOI Listing
July 2017

Injection drug use among female sex workers in Iran: Findings from a nationwide bio-behavioural survey.

Int J Drug Policy 2017 06 4;44:86-91. Epub 2017 May 4.

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Electronic address:

Background: Globally, one in three women who inject drugs is involved in sex work which increases their vulnerability to sexually transmitted infections including HIV. This study was conducted to improve our understanding of injection drug use practices among Iranian female sex workers (FSWs) and shed light on the high-risk profile of FSWs who inject drugs (FSW-IDUs).

Methods: This survey was conducted in 2010, by recruiting 872 FSWs through facility-based sampling from 21 sites in 13 cities in Iran. Data were collected through face-to-face interviews and lifetime injection drug use was assessed through the responses to the question "Have you ever injected any illicit drugs?". Independent variables included a range of socio-demographic and risk characteristics. Logistic regression models were applied to investigate the correlates of lifetime history of injection drug use.

Results: Median (Q1, Q3) age of the participants was 30 (25, 37) and a total of 127 (14.6%, 95% confidence interval (CI): 12.3-17.1) had ever injected drugs. In the multivariable logistic regression model, older age (adjusted odds ratio (AOR)=AOR=3.37, 95% CI: 1.64, 7.70; AOR=2.80, 95% CI: 1.11, 7.10), longer duration (>5 years) of involvement in sex work (AOR=1.06, 95% CI: 1.02, 1.10), and history of drinking alcohol (AOR=4.42, 95% CI: 2.67, 7.32) were positively associated with lifetime history of drug injection and younger age at sex work debut (AOR=0.52, 95% CI: 0.28, 0.96) was negatively associated with lifetime history of illicit drug injection among FSWs.

Conclusion: The prevalence of injection drug use among FSWs in Iran is concerning. Given the potential of this sub-population in bridging HIV into the general population, gender-sensitive and peer-led harm reduction programs should be further scaled up to meet the special needs of this vulnerable population.
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http://dx.doi.org/10.1016/j.drugpo.2017.03.011DOI Listing
June 2017

National population size estimation of illicit drug users through the network scale-up method in 2013 in Iran.

Int J Drug Policy 2016 05 13;31:147-52. Epub 2016 Feb 13.

Community Medicine Specialist, Ministry of Health, Tehran, Iran.

Background: For a better understanding of the current situation of drug use in Iran, we utilized the network scale-up approach to estimate the prevalence of illicit drug use in the entire country.

Methods: We implemented a self-administered, street-based questionnaire to 7535 passersby from the general public over 18 years of age by street based random walk quota sampling (based on gender, age and socio-economic status) from 31 provinces in Iran. The sample size in each province was approximately 400, ranging from 200 to 1000. In each province 75% of sample was recruited from the capital and the remaining 25% was recruited from one of the large cities of that province through stratified sampling. The questionnaire comprised questions on demographic information as well as questions to measure the total network size of participants as well as the network size in each of seven drug use groups including Opium, Shire (combination of Opium residue and pure opium), Crystal Methamphetamine, heroin/crack (which in Iranian context is a cocaine-free drug that mostly contains heroin, codeine, morphine and caffeine with or without other drugs), Hashish, Methamphetamine/LSD/ecstasy, and injecting drugs. The estimated size for each group was adjusted for transmission and barrier ratios.

Results: The most common type of illicit drug used was opium with the prevalence of 1500 per 100,000 population followed by shire (660), crystal methamphetamine (590), hashish (470), heroin/crack (350), methamphetamine, LSD and ecstasy (300) and injecting drugs (280). All types of substances were more common among men than women. The use of opium, shire and injecting drugs was more common in individuals over 30 whereas the use of stimulants and hashish was largest among individuals between 18 and 30 years of age.

Conclusion: It seems that younger individuals and women are more desired to use new synthetic drugs such as crystal methamphetamine. Extending the preventive programs especially in youth as like as scaling up harm reduction services would be the main priorities in prevention and control of substance use in Iran. Because of poor service coverage and high stigma in women, more targeted programs in this affected population are needed.
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http://dx.doi.org/10.1016/j.drugpo.2016.01.013DOI Listing
May 2016

Developing a Brief Scale to Measure HIV Transmission Risk Among Injecting Drug Users.

Int J High Risk Behav Addict 2015 Dec 12;4(4):e26159. Epub 2015 Dec 12.

Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

Background: One of the main concerns of policymakers is to measure the impact of harm reduction programs and different interventions on the risk of HIV transmission among Injecting Drug Users (IDUs). Looking simultaneously at multiple factors and conditions that affect the risk of HIV transmission may provide policymakers a better insight into the mixed nature of HIV transmission.

Objectives: The present study aimed to design a simple, brief, and multi-dimensional scale for measuring HIV transmission risk among IDUs.

Patients And Methods: From October 2013 to March 2014, we conducted face-to-face interviews with 147 IDUs. Eligible participants were individuals 18 years or older who had injected drugs at least once during the last year and had not participated in similar studies within the 2 months before the interview. To design a scale for measuring HIV transmission risk, we specified 11 items, which address different dimensions of HIV risk taking behaviors/situations based on experts' opinion. We applied exploratory factor analysis (EFA) with principal component extraction to develop scales. Eigen values greater than 1 were used as a criterion for factor extraction.

Results: We extracted 7 items based on first factor, which were accounted for 21% of the variations. The final scale contained 7 items: 4 items were related to injecting practice and 3 items related to sexual behaviors. The Cronbach's α coefficient was 0.66, acceptable for such a brief scale.

Conclusions: Applying a simple and brief scale that incorporates the different dimensions of HIV transmission risk may provide policymakers and harm reductionists with a better understanding of HIV transmission in this key group and may be advantageous for evaluating intervention programs.
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http://dx.doi.org/10.5812/ijhrba.26159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744901PMC
December 2015

Network Location and Risk of Human Immunodeficiency Virus Transmission among Injecting Drug Users: Results of Multiple Membership Multilevel Modeling of Social Networks.

Addict Health 2015 Winter-Spring;7(1-2):1-13

Professor, Safety Promotion and Injury Prevention Research Center AND Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Despite the implementation of harm reduction program, some injecting drug users (IDU) continue to engage in high-risk behaviors. It seems that there are some social factors that contribute to risk of human immunodeficiency virus (HIV) transmission in IDUs. The aim of this study was to analysis the social network of IDUs and examines the effect of network location on HIV transmission risk using the multiple membership multilevel models.

Methods: From October 2013 to March 2014 we conducted face-to-face interviews on 147 IDUs. We asked participants to nominate up to 20 people whom they had more than causal contact with them during the last month and specify if each nominee is drug injector or not. We defined four Network locations as Core and Peripheries of main components. The risk of HIV transmission for each individual was measured based on 7 items scale. We applied Multiple Membership Multilevel Linear Regression analysis to examine the relationship between network location and HIV transmission risk. We used Stata and UCINET software's for the analysis of data.

Findings: The mean age of participants was 37 ± 9.32. Most of the individuals were male, single and educated up to guidance school. Being a core member of the main component as like as being a member of other small components in comparison with Isolates/unlinked significantly increased the HIV Transmission risk. Engagement in methadone maintenance therapies (MMT) was associated with a decrease in HIV transmission score.

Conclusion: Network analysis is a useful guide to find the most influential members of IDUs network and may have a complementary role for harm reduction program. The efficacy of interventions programs can be reinforced by addressing them to core individuals within the network. Furthermore, it provides the harm reduction staff to find the broader number of IDUs who are usually hard to reach by routine outreach case-finding tasks.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530188PMC
August 2015

Effects of opium consumption on coronary artery disease risk factors and oral health: Results of Kerman Coronary Artery Disease Risk factors Study a population-based survey on 5900 subjects aged 15-75 years.

Int J Prev Med 2015 20;6:42. Epub 2015 May 20.

Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran ; Global Health Sciences, University of California, San Francisco, CA, USA.

Background: Opium abuse as a relatively common behavior among Iranian population may have an association with the other coronary artery disease (CAD) risk factors. Here, we reported the prevalence of opium abuse and its co-exposures with oral health and other CAD risk factors.

Methods: We recruited 5900 inhabitant aged 15-75 years using a randomized cluster household survey. All were interviewed for level of physical activity (PA), depression, anxiety and opium use and assessed for hypertension, diabetes, hyperlipidemia, and oral health status. Regarding to opium abuse, participants were grouped into: "Non-," "occasional," and "dependent" users. Using logistic regression model for every CAD risk factor, we assessed whether the co-exposure of opium and CAD risk factor is significant.

Results: Overall, 10.6% reported ever opium use including 5.6% dependent and 5% occasional users. The prevalence of opium abuse was increased from 2.1% in 15-25 years to 24.5% in 55-64 years group. Opium abuse, in occasional and dependent forms, was associated with depression (adjusted odds ratio [AOR] 1.81 and 2.49) and low PS (AOR 1.43 and 1.71 respectively). Dependents were less obese than nonusers (P < 0.01). Opium abuse had no significant association with hypertension, diabetes, oral health status and lipid profile.

Conclusions: Opium abuse was associated with depression and low PA. No ameliorative effect was observed on hypertension, diabetes, and plasma lipid profile. Therefore, positive association of opium with depression and LPA and the incorrectness of belief on its ameliorative effect on three other important risk factors of CAD should be clearly highlighted in public health messages to the community.
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http://dx.doi.org/10.4103/2008-7802.157470DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455126PMC
June 2015

The association of insulin-like growth factor-1 with severity of coronary artery disease.

J Cardiovasc Med (Hagerstown) 2013 Jun;14(6):416-20

Endocrinology Department, Kerman Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran.

Aim: Insulin-like growth factor-1 (IGF-1) has been identified as a valuable indicator for impaired glucose tolerance, and its relationship with the presence of coronary atherosclerosis has been also suggested. A few studies have assessed the relationship between IGF-1 level and severity of atherosclerosis. In the present study, the relationship between IGF-1 and coronary artery disease (CAD) was examined with particular attention to the association between this parameter and Gensini score as a good angiographic marker for determining extension and severity of CAD.

Methods: One hundred and seven patients with suspected CAD consecutively referred for selective coronary angiography at the Shafa Hospital in Kerman between April and September 2010 were prospectively enrolled. Total IGF-1 was measured using radioimmunoassay methods (Diagnostics Systems Laboratory, Iran). Selective coronary angiography was performed for all study patients and the Gensini score is computed by assigning a severity score to each coronary stenosis according to the degree of luminal narrowing and its importance based on location.

Results: According to the Spearman correlation analysis, total IGF-I was directly correlated with Gensini score (Spearman's rho = 0.362, P = 0.041). Total IGF-I was slightly related to the number of involved coronary vessels (P = 0.058). Relation between age-adjusted and sex-adjusted mean total IGF-I levels with Gensini score remained significant (P = 0.046); however, the association between IGF-1 and the number of diseased vessels lost statistical significance after this adjustment.

Conclusion: IGF-1 appears as a positive indicator for severity of CAD assessed by the Gensini score, and thus its concentration may be an important indicator for assessing the extent of coronary artery involvement.
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http://dx.doi.org/10.2459/JCM.0b013e328358c7c7DOI Listing
June 2013

The relationship between infantile atopic dermatitis and urinary tract infection.

Iran J Allergy Asthma Immunol 2009 Dec;8(4):211-4

Department of Pediatric Dermatology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran.

Atopic dermatitis (AD) is one of the most common infantile diseases. Immunological dysfunctions in AD patients may predispose them to infections. The aim of this study was to evaluate the relationship between infantile AD and urinary tract infection (UTI).In this cross sectional study, we enrolled 57 patients with AD aged 1 to 24 months that referred to dermatology clinic, and 57 healthy controls who were referred to pediatric clinic. The groups were matched according to age and gender. Urine samples were collected by clean-voided bag method. If a single organism was cultured at concentration of > or = 105 organisms per millimeter and the existence of white blood cells more than 10 per microscopic field was seen the patients underwent suprapubic aspiration. The presence of one organism in suprapubic aspiration sample was regarded as positive culture. Data were analyzed using SPSS version 15 software. P value <0.05 was considered as the level of significance. Twelve (21.1%) of AD patients and 1(1.8%) of normal controls had positive urine culture tests. The difference between two groups was statistically significant (p = 0.001). The most common bacteria was E-coli. Infants with AD showed a higher frequency of UTI in this study. So, we suggest screening all AD infants for urinary tract infection.
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http://dx.doi.org/08.04/ijaai.211214DOI Listing
December 2009

Opium addiction and severity of coronary artery disease: a case-control study.

J Res Med Sci 2010 Jan;15(1):27-32

Associate Professor of Cardiology, Department of Cardiology and Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran.

Background: Coronary artery disease (CAD) is a leading cause of morbidity and mortality in the world. Determination of the risk factors and high risk groups plays an important role in the prevention and controlling programs. The present study aims to determine the relationship between opium consumption and severity of CAD.

Methods: In this hospital based case-control study, 299 patients who were candidates for coronary angiography from 2006 to 2007 were recruited. The patients' history of opium addiction was taken. Based on their history, they were categorized into three groups: non users, occasional users and current users. The relationship between opium addiction and severity of CAD was analyzed by a multiple logistic regression model, STATA v.10.

Results: According to angiographic data, patients were divided into 3 groups: 84 patients (28.09%) as non coronary artery disease, 81 patients (27.09%) as mild CAD and the remaining 134 patients (44.82%) as severe CAD. Univariate analysis showed that current opium users had higher odds of severe CAD compared with non users. Multivariate analysis showed a significant relationship between age, diabetes, hyperlipidemia, gender and severity of coronary artery stenosis.

Conclusions: The findings indicated that current opium users - in comparison with non users - have a higher risk for severe CAD. But it is roughly confounded by other co-factors such as cigarette smoking, age and sex. A dose-response was noticed between the type of opium consumption and the severity of CAD.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3082781PMC
January 2010

Potential of human umbilical cord matrix and rabbit bone marrow-derived mesenchymal stem cells in repair of surgically incised rabbit external anal sphincter.

Dis Colon Rectum 2009 Oct;52(10):1753-61

Department of Surgery, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran.

Purpose: Anal sphincter defects and fecal incontinence are complicated surgical problems. We investigated the ability of human umbilical cord matrix (hUCM) and rabbit bone marrow (rBM) stem cells to improve anal sphincter incontinence due to induced sphincter defects without surgical repair.

Methods: We harvested hUCM cells from human Wharton's jelly and rBM stem cells from rabbit femurs and tibias. To induce sphincter defects, we made an incision in the external anal sphincter. Rabbits were randomly allocated to 5 groups to receive either no intervention (n = 3) or injections of 10 hUCM cells in medium (10 microL RPMI-1640), rBM cells in medium, medium only, or normal saline (n = 7 per group), 2 weeks after sphincterotomy. Transplanted cells were tracked in the injured sphincters by prelabeling with bromodeoxyuridine. Electromyography was performed before and 2 weeks after the external anal sphincterotomy, and 2 weeks after cell transplantation. We also evaluated the proliferation and differentiation of injected cells with histopathologic techniques.

Results: Electromyography showed significant improvement in sphincter function 2 weeks after local injection of rBM stem cells compared with pretreatment values and controls. Moderate, nonsignificant improvement was observed with hUCM cell injection. Cells with incorporated bromodeoxyuridine were detected at the site of injury after transplantation of hUCM and rBM. Histopathologic evaluation showed normal or muscle-dominant sphincter structure in all animals receiving rBM and fibrous-dominant sphincter structure in most animals receiving hUCM.

Conclusions: Stem cell injection at the site of injury can enhance contractile function of the anal sphincter without surgical repair. Transplantation of stem cells, particularly bone marrow mesenchymal cells, may provide an effective tool for treating anal sphincter injuries in humans.
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http://dx.doi.org/10.1007/DCR.0b013e3181b55112DOI Listing
October 2009

Lead serum levels in opium-dependent individuals.

Addict Health 2009 ;1(2):106-9

General Practitioner, Kerman University of Medical Sciences, Kerman, Iran.

Background: Drug abuse, especially opium abuse, is a major public health problem in Iran. Recent reports suggest that opium sellers cheat their customers by adding lead to the opium. Contaminated opium can threaten the health of consumers. The present study aimed to compare the serum level of lead between opium dependents and a control group.

Methods: This was a cross-sectional study in which 50 opium dependents aged 20 to 60 years old were compared with a control group of 43 non-dependents who were matched with the case group in terms of sex and age. The serum level of lead and liver function tests including serum total bilirubin, AST, ALT, Alkaline-phosphatase and hemoglobin were measured for all subjects.

Findings: The mean level of serum lead concentration in opium dependents and controls was 3929.358 ± 147.67 and 3532.721 ± 1141.53, respectively and the difference was not statistically significant. There was no significant correlation between serum level of lead and age, duration of opium dependency, serum total bilirubin, hemoglobin, AST, ALT, and Alkaline-phosphate.

Conclusion: Although there was no significant relationship between opium consumption and serum level of lead, the concentration of lead in dependents' serum was higher than controls. Further studies are needed to approve this relationship to be used for screening and on time diagnosis of opium dependents.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905488PMC
February 2014