Iranian Journal of

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Background & Objectives: According on surveys in Iran more than two million persons have non insulin diabetes mellitus. There are evidences that good glycemic control reduces the risk of diabetic complications. This study was designed to evaluat the glycemic control by using fasting blood sugar and hemoglobin A1C estimation and their relation with some variables.
Methods: This cross sectional study carried out on 411 people with type 2 diabetes who referred to Tawhid diabetes center in Sanandaj. Demographic and other variables were gathered by a deigned questionnaire. Univariate analysis and multivariate analysis (logistic regression) were used. Results: In Univariate analysis FBS showed a significant relationship with education, job and referral style and HgA1c was statistically significant with sex, age, education, and job. But logistic regression showed other
Results: in final model FBS and HgA1c were associated with body mass index and referral style and HgA1c had association with only body mass index and referral style. Correlation confidence between FBS and glycated hemoglobin was (r = 0.54).
Conclusions: It is concluded that BMI and referral style have association with diabetes control.

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Background & Objectives:
Nowadays the performance of hospital blood banks is assessed by cross-match to transfused unit ratio which it is recommended to be less than 2.0. The aim of this study was to evaluate the most common indications for blood transfusion in Qum University hospitals.
Methods: In this retrospective study 4370 blood order forms from March 2010 till April 2011 were assessed. To calculate C/T ratio, the number of cross-matched units was divided by the number of transfused units.
Results: Of total 4370 blood order, 57.1% were male. From all blood order forms, 16.42% (C/T : 1.196) were not transfused. The highest rate of blood orders pertained to surgery emergency and trauma (23.3%), hematology and oncology (14%), gynecology (11.3%), internal ward and nephrology (8%), infectious ward (6.9%), burn ward (5.9%), general surgery (4.4%), orthopedics (3.2%), ICU (2.3%) and pediatrics (8.6%).         Packed cell was the product with the highest order rate of 78.7% in Qom teaching hospitals however, out of this rate 44% remained untransfused.
Conclusion: According to the findings of this study the rate of non-transfused ordered blood components in Qom teaching hospitals seems very high. Thus, it is recommended to employ the international and/or national guidelines in order to reach to optimal rate.

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Background and Objectives: Since there is inconsistency reports in relationship between shift work (SW) and blood pressure (BP), therefore we aimed to show any association between SW and BP by using of Bayesian Multilevel Modeling, which is a reliable method for this type of analysis.
 Methods: The profiles of 4145 workers in Polydactyl Iran Corporation were examined in historical cohort between 1996 until 2008. All relevant analysis was performed by Win Bugs software.
Results: Approximately 98 percent of study population was male. Of total 1886 (45.5%), 307(7.4%), 1952 (47.1%) of participation were day worker, two rotation shift worker and three rotation shift worker respectively. After controlling confounding factors, there was no significant relationship with Systolic BP (P=0.911) and Diastolic BP (P=0.278).
Conclusion: In general, the results of our historical cohort study do not support a relationship between SW and BP. We suggest multi center and prospective cohort studies with controlling more confounding factors in this area.

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Background & Objectives: Prevalence of cytomegalovirus (CMV) infection varies is highly prevalent in different societies. CMV infection in susceptible patients is associated with serious morbidity and a high mortality and is a matter of concern for blood bank professionals and blood transfusion recipients, especially in cases of transfusions to neonates and immunocompromised patients. Thus, the present study aimed to determine the prevalence rate of anti-CMV antibodies among the blood donors of Mashhad Blood Transfusion Center.
 Methods: This seroepidemiology study carried out on 1008 samples from blood donors in Mashhad Blood Transfusion Center and the prevalence rate of anti-CMV antibodies (IgM, IgG) was estimated by ELISA method in the samples
Results: Out Of 1008 serum samples from donors, 1000 persons (99.2%) had anti-CMV IgG and 16 donors (1.6%) had anti-CMV IgM in their sera. Eight (8) persons had no anti-CMV IgG and IgM in their sera.
Conclusion: The high rate of prevalence of CMV in this study region indicating blood component screening strategies for blood transfusions require particular attention among healthcare professionals as part of the actions for prevention and reduction of primary infections caused by CMV.

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  Background & Objectives : Considering the high prevalence of hypertension and its increasing trend in Iran as the most important known modifiable risk factor of stroke, this study was performed to determine the pattern of hypertension and the related population attributable fraction (PAF) of stroke in Hamadan Province.

  Methods: Blood pressure data of over-19-year-old population of Hamadan Province from 2005 to 2009 was extracted from the non-communicable diseases risk factors surveillance system . The point prevalence and 95% confidence interval (95% CI) of hypertension was reported in the study population according to sex and age groups. The trend of hypertension was depicted using a line plot. To calculate PAF, the data of the prevalence of hypertension in 2009 was used. Corresponding hazard ratio was obtained from the available literature.

  Results : The prevalence of hypertension was 9.4 (8.2 – 10.6) in 2005, 7.5 (5.9 – 9.3) in 2006, 14.2
(12.1 – 16.5) in 2007, 13.8 (11.7 – 16.1) in 2008, and 12.2 (10.3- 14.5) in 2009. The mean and standard deviation of systolic blood pressure was 120.88 (19.73) and 124.19 (19.24) in the participants in 2005 and 2009, respectively. The study results showed that 19.84% of the strokes in Hamadan Province were due to hypertension .

  Conclusion: The results of this study confirmed the considerable contribution of hypertension to stroke in Hamadan Province. Accordingly, policy makers are strongly recommended to consider controlling and preventive strategies for hypertension as a priority .

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Background & Objectives: Considering the importance of CVD risk factors in diabetic and non-diabetic populations and the high prevalence of diabetes and cardiovascular risk factors, we studied the trend of anthropometric indexes, blood pressure, smoking and lipids in diabetic and non-diabetic populations.

Methods: The data of Tehran Lipid and Glucose Study was used in this investigation. The study population comprised 1045 diabetic and 5136 non-diabetic subjects. To investigate the secular longitudinal trends, the Generalized Estimation Equation method was employed. All statistical models were adjusted for age to eliminate the potential confounding effect of age. The interaction between the diabetes status and each phase of the study was checked in a separate model in GEE.

Results: Over a decade, the serum levels of TC, TGs, LDL-C and non HDL-C decreased although about 60% of the diabetic population did not reach the therapeutic goals of non-HDL-C and LDL-C levels until 2011. Control of hypertension was more successful in females, but about 60% of both males and females with diabetes were still hypertensive at the end of follow-up period. Smoking increased during the follow-up.

Conclusion: This study showed that among CVD risk factors, healthcare professionals paid more attention to hypercholesterolemia neglecting other risk factors including hypertension and central obesity.

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Background and Objectives: Diabetic patients are always at risk of hypertension. In this paper, the main goal was to design a native cost sensitive model for the diagnosis of hypertension among diabetics considering the prior probabilities.

Methods: In this paper, we tried to design a cost sensitive model for the diagnosis of hypertension in diabetic patients, considering the distribution of the disease in the general population. Among the data mining algorithms, Decision Tree, Artificial Neural Network, K-Nearest Neighbors, Support Vector Machine, and Logistic Regression were used. The data set belonged to Azarbayjan-e-Sharqi, Iran.

Results: For people with diabetes, a systolic blood pressure more than 130 mm Hg increased the risk of hypertension. In the non-cost-sensitive scenario, Youden's index was around 68%. On the other hand, in the cost-sensitive scenario, the highest Youden's index (47.11%) was for Neural Network. However, in the cost-sensitive scenario, the value of the imposed cost was important, and Decision Tree and Logistic Regression show better performances.

Conclusion: When diagnosing a disease, the cost of miss-classifications and also prior probabilities are the most important factors rather than only minimizing the error of classification on the data set.

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Background and Objectives: Regular blood transfusions in patients with hereditary hemolytic anemia, especially thalassemia, increase the survival of most patients but also may result in infection with viruses like hepatitis. In order to identify these diseases and other complications in people with thalassemia, this study aimed to investigate epidemiological and clinical findings in patients with thalassemia in Dezful in 2015.
Methods: In this descriptive-analytic study, data were collected from medical records in Dezful thalassemia Clinic by the census method. The collected data included gender, age, location, ethnicity, blood type, transfused blood type, time between blood transfusions, medications, vaccinations, underlying diseases, and operations and their time.
Results: The records of 174 thalassemia patients with a mean age of 23.60 years were evaluated. Of these, 23 patients (13.2%) had thalassemia intermediate and 151 (86.8%) had thalassemia major. The last mean serum ferritin was 2760.60. Independent T test showed a significant relationship between the type of thalassemia and age at diagnosis (P=0.000). There was a significant positive correlation between age and blood transfusion intervals so that the intervals increased with age (P=0.004) (r=0.21).
Conclusion: The high mean age in the center compared to other studies as well as the low frequency of side effects indicate the effectiveness of new treatments and increased survival of these patients.

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Background and Objectives: In Iran, rainbow trout farms exist in almost all provinces. Viral hemorrhagic septicemia is one of the most important infectious diseases of the rainbow trout which is a serious threat to the farming industry. This study was conducted to investigate outbreaks in 2014 and identify important determinants of the agent entry and disease occurrence in the farms.
Methods: Data were collected using a structured questionnaire and the disease was detected based on clinical signs and laboratory investigations by PCR methods.
Results: During 52 weeks of the study in 2014, 114 of 1140 (12.63%) farms were affected within 78 zones in 14 provinces. In multivariable analysis, illegal entrance of fries (odds ratio: 7.81, 95% CI: 3.63-16.8), illegal entrance of fish (odds ratio: 5.60, 95% CI: 3.03-10.35) and use of river as the water supply (odds ratio: 2.46, 95% CI: 1.51-4.02) were detected as risk factors associated with virus entry and disease outbreak in farms.
Conclusion: Observing biosecurity measures in the farm level, applying risk-based surveillance based on known risk factors, and assessing these factors on a regular basis are important in prevention and control of VHS.    

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Background and Objectives: Shift work as a pervasive phenomenon in various industrial sectors is one of the most stressful factors in the workplace. Considering the contradictory reports on the relationship of shift work and hypertension, the main objective of the present study was to investigate the relationship between these two variables among petrochemical industry staff of Mahshahr, Iran.
Methods: In this longitudinal study, 3254 petrochemical staff were investigated during 2008-2011. According to work schedule, shift workers were divided into two groups of shift work and day work (1872 day workers and 1382 shift workers). The aim of this research was to assess the effect of shift work on hypertension by adjusting confounding variables such as gender, age, body mass index, and smoking. The data were analyzed using a random-effects logistic regression model.
Results: Of 3254 (3142 males and 112 females) subjects, 37.85% (860 subject) were hypertensive. The random effects model, with controlling covariates, showed no significant relationship between shift work and hypertension (OR=1.04, 95% CI= (0.98, 1.10). Moreover, the variance of the random effects was significant. 
Conclusion: Generally, according to the results of this study, shift work is not a significant risk factor for hypertension.

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Background and Objectives: Epidemics of diarrhea caused by contaminated food and water occur frequently worldwide, especially in developing countries. The aim of this study was to identify the factors contributing to the development and spread of diarrhea epidemics caused by Shigella  flexneri  in Isfahan in the spring of 2015.
 
Methods: Following the first reports and activation of the surveillance system, a matched case-control study was conducted in 360 cases with diarrhea and 360 controls. Data were gathered using a questionnaire, and conditional logistic regression was used to provide adjusted odds ratios and 95% confidence intervals.
 
Results: Consumption of contaminated fresh vegetable (OR=4.50, 95% CI=2.88-7.01) was the source of the epidemic. Contact with similar patients (OR=7.19, 95% CI=4.26-12.12), presence of similar patients in the family (OR=33.2, 95% CI=13.64-80.82), food consumption on special events (party, wedding ceremony, funeral, etc.) (OR=1.67, 95% CI=1.06-2.62), being a government employee (OR=3.08, 95% CI=1.64-5.78) and being illiterate (OR=2.91, 95% CI=1.10-7.67) were the risk factors of the spread of the epidemic.
 
Conclusion: In this study, consumption of fresh vegetable contaminated with Shigella flexneri was the source of the infection. According to the Epidemic Management Team, contamination occurred due to non-standard wastewater irrigation of agricultural lands. Therefore, it is important to consider the standards of agricultural production and compilation of a comprehensive program to improve the status of the wastewater purification system in the environmental sciences by the relevant organizations to prevent diarrhea epidemics.

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Background and Objectives: The Cox model is one of the methods used in survival data; however, the use of hierarchical data, such as the data of this study, violates the assumption of independence, the the Cox model cannot be used  assuming independence of observations. One of the important methods for analyzing survival hierarchy data is the use of the multilevel Cox model. In this method, in addition to modeling the response variable, regression coefficients are also modeled and the measurement error resulting from the lack of data independence is reduced. The present study used a multilevel Cox model to investigate the effect of the retention of antihypertensive drugs in people with hypertension.
 
Methods: This longitudinal survival study was conducted in 346 workers with hypertension in Mobarakeh Steel Company in Isfahan. During the years 1390-1394, when the staff attended the health center in the factory, they were treated with six drugs, including captopril, losartan, atenolol, propranolol, amlodipine, and hydrochlorothiazide. In order to examine the relationship of the retention of drugs with job experience, body mass index, and drug history, a two-level Cox model was used as h_ij (t)=h_0 (t)exp⁡(α_g+x_ij β_j), where i and j is the first and second level units, respectively.
 
Results: During five years, the findings of model fitting showed the effect of body mass index (P = 0.019), atenolol (P=0.046), and amlodipine (P=0.021) in a single form, and the effect of losartan-amlodipine ¬(P=0.042) and atenolol-hydrochlorothiazide (P = 0.003) in a combination form were significant.
 
Conclusion: Based on the study results, the most effective drugs for hypertension control are amlodipine monotherapy, amlodipine-losartan combination therapy, and atenolol monotherapy, respectively.

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Background and Objectives: Hypertension is a major global issue due to its consequences. Ordinary regression models have limitations in assessment of hypertension since the reference graph derived from a specific population may not be appropriate for another population. The polynomial quantile regression model is considered as a possible alternative. Hence, this study was conducted with the aim of determining reference values as well as blood pressure percentile curves in Mashhad.
 
Methods: This cross-sectional study was carried out in a random sample of 6949 individuals attending Samen health centers for diabetes screening in 2010. Different percentiles were analyzed using some variables such as gender, age, BMI, WHR, and systolic and diastolic blood pressure. The R software (version 3.0.1) was used for data analysis.
 
Results: In this study, 70.58% and 29.42% of subjects were men and women, respectively. The results of the quantile regression model showed that with an increase in age, BMI, and WHR, blood pressure increased in all percentiles. In all variables, subjects in the 75th and 95th percentiles had moderately high and high blood pressure while they had a normal blood pressure in other percentiles.
 
Conclusion: The model provided more information about blood pressure and its related patterns. According to the results, it seems that more attention should be paid to elderly and overweight individuals in the 75th and 95th percentiles.

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Background and Objectives: Chronic renal failure (CRF) is an irreversible disorder of the renal function. The aim of this study was to  describe the features of patients with chronic renal failure and the factors associated with this disease among hemodialysis patients in a hospital in Tehrn in 2016.
 
Methods: In this cross-sectional descriptive study, patients presenting to the hemodialysis department of Shahid Ayatollah Ashrafi Esfahani Hospital who underwent continuous hemodialysis treatment for at least three months were studied. Data were gathered from the medical records of the patient s and, if necessary, additional interviews were conducted with the patients. Data were analyzed with descriptive and inferential statistics using the Stata software version 14.
 
Results: Of 359 patients, 230 (64.07%) were male with a mean age of 58.1 ± 1.09 years. The frequency (frequency percentage) of the most commonly known possible causes of renal failure was hypertension 91 (25.35%), hypertension and diabetes 84 (23.43%), and diabetes 78 (21.73%). The mortality rate was higher in diabetic patients compared to non-diabetic patients (50% vs 38.55%).
 
Conclusion: The main cause of chronic renal failure is hypertension and diabetes, and the mortality rate is higher in these patients than in other patients.

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Background and Objectives: To provide an overview of the national program of Crimean-Congo hemorrhagic fever surveillance in Iran, its current achievements, and challenges.
 
Methods: In this mixed method study, the relevant reports, documents, and guidelines, as well as published literature and surveillance data were gathered and critically reviewed. The opinions of the key informants at local and governmental levels were assessed through structured interviews.
 
Results: The program was integrated into Iran’s primary healthcare (PHC) network in 1999. The involved organizations include CDC, medical universities, Pasteur Institute of Iran (PII), and Veterinary Organization. Case finding is based on standard definitions of suspected, probable, and confirmed cases. Laboratory confirmation is necessary for diagnosis and is provided within 48 hours after receipt of the specimen by the National Reference Laboratory of PII. CCHF treatment is primarily supportive. Antiviral therapy with ribavirin is also considered. Both therapeutic services are free. Education mainly focuses on high-risk groups and healthcare workers. Major achievements of the program include rapid diagnosis and treatment of cases, prevention of nosocomial transmission, identification of high-risk provinces and major transmission routes, improved outbreak preparedness, development of laboratory tests for detection of other arboviruses, and reduction of CCHF case fatality rate.
 
Conclusion: Program implementation has had a positive impact on early detection and proper control of annual outbreaks. However, some aspects of the program still need improvement, including promotion of the general and high-risk populations’ awareness and regional collaborations (especially among neighboring countries) for infection control in humans, livestock, and vectors.

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Background and Objectives: Correct and timely detection of the outbreaks of diseases with a short incubation period is of great importance in the health system. The aim of this study was to determine the detection of dysentery outbreaks using the cumulative sum method.
 
Methods: This time series study was conducted using the data of the National Surveillance System between 2014 and 2017. The outbreak alert threshold of each season and province was determined separately using the average of three years (1393 to 1395) in the same season and province. The dysentery outbreak in each season was exclusively predicted for Isfahan, Khuzestan, and Hamadan provinces in 2017 using the CUSUM method.
 
Results: In Isfahan Province, the outbreak alert was higher in the spring and summer and lower in the autumn and winter using the current method compared to the CUSUM method. For Khuzestan Province, the current outbreak alert was significantly higher in all seasons compared to the CUSUM method, while the current outbreak alert was lower than the alert predicted by the CUSUM method in Hamadan Province in all the seasons.
 
Conclusion: Compared to constant threshold-based methods, using the CUSUM method seems to be a better way for reporting outbreaks, especially in areas with a high incidence.

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