Publications by authors named "Sima Oshnouei"

10 Publications

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Epidemiological factors and worldwide pattern of Middle East respiratory syndrome coronavirus from 2013 to 2016.

Int J Gen Med 2018 6;11:121-125. Epub 2018 Apr 6.

Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran.

Background: Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging threat to global health security with high intensity and lethality. This study was conducted to investigate epidemiological factors and patterns related to this disease.

Methods: Full details of MERS-CoV cases available on the disease outbreak news section of the World Health Organization official website from January 2013 to November 2016 were retrieved; demographic and clinical information, global distribution status, potential contacts, and probable risk factors for the mortality of laboratory-confirmed MERS-CoV cases were extracted and analyzed by following standard statistical methods.

Results: Details of 1,094 laboratory-confirmed cases were recorded, including 421 related deaths. Significant differences were observed in the presentation of the disease from year to year, and all studied parameters differed during the years under study (all -values <0.05). Evaluation of the effects of various potential risk factors of the final outcome (dead/survived) revealed that two factors, namely, the morbid case being native and travel history, are significant based on a unifactorial analysis ( <0.05). From 2013 to 2016, these factors remained important. However, factors that were significant in predicting mortality varied in different years.

Conclusion: These findings point to interesting potential dimensions in the dynamic of this disease. Furthermore, effective national and international preparedness plans and actions are essential to prevent, control, and predict such viral outbreaks; improve patient management; and ensure global health security.
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http://dx.doi.org/10.2147/IJGM.S160741DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896642PMC
April 2018

N-acetyl cysteine in ovulation induction of PCOS women underwent intrauterine insemination: An RCT.

Int J Reprod Biomed 2017 Apr;15(4):203-208

Department of Obstetrics and Gynecology, Urmia Reproductive Health Research Center, Urmia, Iran.

Background: N-acetyl cysteine (NAC) was proposed as an adjuvant to clomiphene citrate for ovulation induction in patients with polycystic ovary syndrome (PCOS) without clomiphene citrate resistance.

Objective: To evaluate the effect of NAC on pregnancy rate in PCOS patients who were candidates for intrauterine insemination.

Materials And Methods: In this randomized clinical trial, 97 PCOS women aged 18-38 years were enrolled in two groups, randomly. For the case group (n=49), NAC (1.2 gr)+ clomiphene citrate (100 mg) + letrozole (5mg) were prescribed daily from the third day of menstruation cycle for five days. The control group (n=48) had the same drug regimen without NAC. In order to follicular development, recombinant human follicle stimulating hormone (r-hFSH; Gonal-F®) was injected on days of 7-11 menstrual cycles in all participants. When the follicle size was 18mm or more, 10000 IU human chorionic gonadotropin was injected intramuscular and the intrauterine insemination was performed after 34-36 hr.

Results: There were not significant differences between study groups regarding mean endometrial thickness (p=0.14), the mean number of mature follicles (p=0.20), and the pregnancy rate (p=0.09).

Conclusion: NAC is ineffective in inducing or augmenting ovulation in PCOS patients who were candidates for intrauterine insemination and cannot be recommended as an adjuvant to CC in such patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555037PMC
April 2017

Fish oil supplementation for primary prevention of atrial fibrillation after coronary artery bypass graft surgery: A randomized clinical trial.

Int J Surg 2017 Jun 15;42:41-48. Epub 2017 Apr 15.

Rajaie Cardiovascular Medical & Research Center, Tehran, Iran.

Background: Atrial fibrillation (AF) after cardiac surgery is a common complication that may influence patients' early and long term outcomes and hospital costs. The purpose of this study was to assess the effect of fish oil on occurrence of AF following coronary artery bypass graft surgery (CABG).

Methods: This study was a single-center, randomized, double blinded, placebo-controlled clinical trial. Four-hundred and one patients undergoing coronary artery bypass graft surgery were randomly assigned to receive 2 g/d fish oil or placebo (olive oil) for at least 5 days before surgery. The primary end point was defined as time to AF improvement After AF incidence following isolated CABG or a need for pharmacologic therapy or cardioversion.

Results: The time to AF improvement in intervention group was shorter than control group (HR: 2.05; 95% CI = 0.70-6.22, P = 0.20). The incidence of AF in the intervention and control groups was 8.40% vs. 14.07% respectively (p = 0.07). Mean total duration of AF was 20.96 ± 4.71 h in intervention groups and 46.87 ± 7.44 h in control groups (p = 0.04). Mean duration of stay in the ICU and total hospital stay showed a significant reduction in the intervention group (p = 0.003 and p = 0.04, respectively).

Conclusion: The consumption of PUFA leads to a shorter time to AF improvement, which was not statistically significant. The incidence of AF in patients undergoing CABG surgery was decreased by approximately 5.7%; which was statistically on the borderline. Fish oil reduced median length of stay in the ICU and hospital. Further well-designed studies are needed to overcome the limitations of the existing trials and provide conclusive conclusions.
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http://dx.doi.org/10.1016/j.ijsu.2017.04.025DOI Listing
June 2017

Association of Helicobacter Pylori Infection and Ectopic Pregnancy.

J Family Reprod Health 2016 Jun;10(2):80-4

Reproductive Health Research Center, Department of Obstetrics and Gynecology, Urmia University of Medical Sciences, Urmia, Iran.

Objective: To evaluate the importance of cytokine type in embryo implantation in uterus specified and activated macrophages interfere the tube movements and embryo retention in uterine tubes by smooth muscle relaxation and disrupting ciliary function. Therefore, increased risk of infection with HP during pregnancy, we investigated relation between Helicobacter pylori (HP) infection and prevalence of ectopic pregnancy (EP) in this study.

Materials And Methods: This is cross-sectional study from March 2012 to May 2013. Totally 207 women were enrolled randomly from which 101 had EP (Case group) and 106 were selected as control group with normal pregnancy. A 2-cc blood sample was taken from each patient to evaluate the specific IgG titer by ELISA method. All results of samples with positive H. pylori IgG were assayed for anti-CagA, IgG antibodies. A questionnaire was filled for each subject. The associations between CagA positive cases with odds of Ectopic pregnancy incidence were analyzed by using SPSS software, ver. 19 (Chicago, IL, USA).

Results: Mean (± SD) of age were 21.0 ± 5.78 and 30.78 ± 5.10 years for cases and controls group respectively. These groups didn't show any significance difference in age and parity.H. pylori IgG antibodies were positive among 99 and 103 (98.2% vs. 97.2%) in women with EP and normal pregnancy respectively. Relationship between IgG status and EP was not significant (OR = 1.31: 95% CI = 0.7-2.52, Pvalue = 0.37). In particular anti-CagA antibodies were positive among 45 and 39(45.92% vs. 36.97%) in women with EP and normal pregnancy respectively. Among women with CagA positive strains had higher odds of Ep (OR = 1.46: 95% CI = 0.8-2.65, Pvalue = 0.18), but it wasn't significant.

Conclusion: According to the result of this study there was not any association between HP infection and Ectopic pregnancy. We recommend more studies with larger sample size for determining the effect of CagA positive strains on EP.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5026672PMC
June 2016

Relationship between progesterone level on the day of human chorionic gonadotropin administration with outcomes of intra-cytoplasmic sperm injection in infertile couples.

Iran J Reprod Med 2015 Jul;13(7):397-402

Reproductive Health Research Center, Gynecology Department, Urmia University of Medical Sciences, Urmia, Iran.

Background: Gonadotropin-releasing hormone agonists or antagonists are used in assisted reproductive technique cycles as premature luteinizing hormone secretion inhibition. Studies have been reported different and contradictory results on the serum progesterone effect on intra-cytoplasmic sperm injection.

Objective: The purpose of this study was to evaluate the effect of serum progesterone level on the day of Human chorionic gonadotropin (HCG) administration on the intra-cytoplasmic sperm injection (ICSI) outcome in infertile women.

Materials And Methods: 249 infertile couples candidated for ICSI were enrolled in the study. Their serum progesterone level on the day of HCG administration was measured and according to serum level, patients were divided into four groups of less than 0.9, 0.9-1.4, 1.5-1.9, and ≥2 ng/mL. The four groups were compared with each other regarding fertility outcomes.

Results: Pregnancy rate was not significantly different among the four groups (p>0.05). Also, there was no significant difference among the groups regarding frequency of abortion and ectopic pregnancy.

Conclusion: Serum progesterone level on the day of HCG administration does not have any significant effect on pregnancy outcomes, including abortion, ectopic pregnancy, and pregnancy rate in patients undergoing ICSI treatment.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609318PMC
July 2015

Novel restricted access to vasectomy in Iran: addressing changing trends in vasectomy clients' characteristics over 16 years in northwestern Iran.

Contraception 2015 Nov 28;92(5):488-93. Epub 2015 Jul 28.

Reproductive Health Research Center, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran. Electronic address:

Objectives: This study is designed to evaluate the popularity of vasectomy in Iran. The study was conducted to calculate the frequency of vasectomy over time, to compare vasectomy users' characteristics with the general population and whether these characteristics have changed over time.

Study Design: A cross-sectional study of 7864 men undergoing vasectomy in a 16-year period was conducted in Urmia, Iran. Comparative statistics described differences between vasectomy users and nonusers. The data were analyzed separately in two 8-year periods, 1996-2003 and 2004-2011. The time period did not involve 2012, the year which vasectomy became outlawed in the whole country.

Results: During the study period, the contraceptive prevalence rate of vasectomy increased from 0.1% to 3.35%. Vasectomy users were predominantly older, better educated, had more children and more urban residents than the general male population (p<0.001). Over time, men who underwent vasectomy tended to be younger, have well-educated wife and rural resident (p<0.05).

Conclusions: This study highlighted a dramatic rise in the use of vasectomy between 1996 and 2011 in Iran. While the characteristics of vasectomy users versus general population were different, especially in age, education, resident area, number and sex of their children, there were significant changes from two 8-year study time periods.
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http://dx.doi.org/10.1016/j.contraception.2015.07.010DOI Listing
November 2015

Persistence of Hemorrhage and Hypertensive Disorders of Pregnancy (HDP) as the Main Causes of Maternal Mortality: Emergence of Medical Errors in Iranian Healthcare System.

Iran J Public Health 2014 Oct;43(10):1395-404

1. Reproductive Health Research Center, School of Public Health, Urmia University of Medical Sciences , Urmia, Iran.

Background: This study aimed to assess factors affecting substandard care and probable medical errors associated with obstetric hemorrhage and HDP at a Northwestern Iranian health care system.

Methods: In a community-based descriptive cross-sectional study, data on all maternal deaths occurred at West Azerbaijan Province, Iran during a period of 10 years from March 21, 2002 to March 20, 2011 was analyzed. The principal cause of death, main contributory factors, nature of care, main responsible staff for sub-standard care and medical error were determined. The data on maternal deaths was obtained from the national Maternal Mortality Surveillance System (MMSS) which were covered all maternal deaths. The "Three delays model" was used to recognize contributing factors of maternal deaths due to obstetric hemorrhage and HDP.

Results: There were 183 maternal deaths, therefore the Mean Maternal Mortality Ratio (MMR) in the province was 32.8 per 100 000 live births (95% CI, 32.64-32.88). The most common causes of maternal deaths were obstetric hemorrhage in 36.6% of cases and HDP in 25.7%. The factors that most contributed to the deaths were all types of medical errors and substandard care with different proportions in management of obstetric hemorrhage and HDP.

Conclusion: A substandard care and medical error was the major contributing factor in both obstetric hemorrhage and HDP leading to maternal mortality, therefore, it is necessary to improve the quality of health care at all levels especially hospitals.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441893PMC
October 2014

Premenstrual syndrome and quality of life in Iranian medical students.

Sex Reprod Healthc 2015 Mar 30;6(1):23-7. Epub 2014 Jun 30.

Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran.

Purpose Of Study: The purpose of this research was to investigate the prevalence of premenstrual syndrome (PMS) in medical students and to evaluate the hypothesis that PMS may result in a decrease in quality of life.

Methods: In a cross-sectional study, 142 female medical students who study at Urmia University of Medical Sciences were included. The data were compiled using a PMS questionnaire based on the fourth version (DSM-IV) criteria, the questionnaire of "Premenstrual Syndrome Scale" as well as the "World Health Organization's Quality of Life (WHOQOL-BREF)" questionnaire.

Findings: In total, 56 out of 142 (39.4%) female medical students met the DSM-IV criteria for PMS. In the PMS group, more than half of the girls, i.e. 60.6% had mild, 25.1% had moderate and 14.2% had severe PMS. PMS was found to be significantly high in students who have positive history of PMS in their first degree relatives and who have used drugs to relieve PMS symptoms (P<0.05). Life quality score was low in more than half of the medical students, especially in psychological and social components (P>0.05). However, the quality of life score means in mental health (P=0.02) and environmental health (P=0.002) decreases as the PMS score average increases.

Conclusion: The results of premenstrual syndrome prevalence and their severity suggest that PMS is common in medical students and this adversely affects some domains of the quality of life. Improving the life quality of female medical students needs some interventions related to the PMS and also other interventions not related to PMS.
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http://dx.doi.org/10.1016/j.srhc.2014.06.009DOI Listing
March 2015

Effects of antibiotic consumption on children 2-8 years of age developing asthma.

Epidemiol Health 2014 4;36:e2014006. Epub 2014 Jul 4.

Department of Pediatrics, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran.

Objectives: Antibiotic exposure in children is a possible contributor to the increasing asthma prevalence in several countries. The present study aimed to investigate the association between antibiotic exposure and the risk of developing childhood asthma at 2-8 years of age.

Methods: A case-control study was undertaken among children aged 2-8 years old between March and September 2010 in the Urmia district in the northwest of Iran. The cases were doctor-diagnosed asthmatic children based on Global Initiative for Asthma criteria (n=207), and the controls were children without respiratory symptoms (n=400) selected by frequency matching by age and gender. Clinical data including antibiotic exposure was collected by a validated and reliable questionnaire, which was completed by interviewing parents/guardians.

Results: Antibiotic consumption during the first year of life increased the odds ratio [OR] of asthma symptoms at 2-8 years of age (crude OR, 2.26; 95% confidence interval [CI], 1.53-3.35; p<0.01), and the strength of association was similar after adjusting for a family history of asthma or atopic disorder, preterm delivery, birth order, and delivery method (adjusted OR, 1.91; 95% CI, 1.27-2.88; p=0.03).

Conclusions: Our study suggests that antibiotic consumption in children was associated with an increased risk of childhood asthma, and an additional confirmative study is needed.
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http://dx.doi.org/10.4178/epih/e2014006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4101990PMC
July 2014

Intimate partner violence during pregnancy in Urmia, Iran in 2012.

J Forensic Leg Med 2014 May 28;24:28-32. Epub 2014 Mar 28.

Reproductive Health Research Centre, School of Public Health, Urmia University of Medical Sciences, Urmia, Islamic Republic of Iran.

Background: In spite of enough prevalence data on Intimate Partner Violence (IPV) during pregnancy from many countries, there are still some regions such as the Middle East with relatively limited data. The purpose of research was to investigate the magnitude of IPV during pregnancy in an Iranian community.

Methods: Thirty hundred fifty women during their postpartum period were invited to participate in a cross-sectional population-based study, but 10.6% of them refused participation. The data was compiled using the Abuse Assessment Screen questionnaire.

Results: Of the 313 women, 55.9% reported violence during pregnancy. All types of violence were detected in victims during pregnancy, including psychological violence (43.5%), physical violence (10.2%), and sexual violence (17.2%). Intimate partner violence during pregnancy was significantly associated with lower education of the husbands (PR 1.64; 95% CI 1.15-2.36), un-employment of the husbands (PR 1.36; 95% CI 1.12-1.64), marriage duration of 5-9 years (PR 0.95; 95% CI 0.74-1.20) and gravidity of two (PR 0.80; 95% CI 0.59-1.08).

Conclusion: The reported prevalence of IPV before and during pregnancy in this sample is substantially higher than estimates of exposure to violence in other parts of the globe, even the East Mediterranean region which has the highest prevalence estimation in the globe.
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http://dx.doi.org/10.1016/j.jflm.2014.03.007DOI Listing
May 2014