Tehran University Medical Journal

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This descriptive study is carried out to determine the effectiveness of family planning programmes in Iran for years 1991-96. The study revealed the following outlines: Contraceptives prevalence rates increased from 42% to 67% during years 1991-96. Zaro couples years of protection increased for norplant, injectable contraceptive, IUD, vasectomy and tubectomy, but for candom it is decreased in year 1996 (Comparing to earlier years of the study). A decrease in use failure rate of contraceptives was observed during the period of the study.

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One of the disturbing complications of propofol is pain on injection and the incidence ranges from 28% to 90%. Metoclopromide is commonly used as an anti emetic drug. Some investigators reported that this drug could reduce the pain on injection of propofol. The aim of this study was to assess and comparison of the efficacy of propofol pretreatment with metoclopromide in incidence and severity of its pain on injection.
Materials and Methods: In a randomized, prospective, double-blinded, placebo-controlled trail, 150 patients 18 to 40 yr old were randomly allocated in one three groups. C group (2ml of normal saline), L group (40mg lidocaine in 2ml), M group (l0mg metoclopromide in 2ml). Immediately after injection of study or placebo drugs, 10 mg of propofol with injection rate of 0.5 ml/s (In 4 Seconds) were injected in to the same vein that was inserted to the most prominent dorsal hand vein. Pain severity was measured using Visual Analogue Pain Scale that were educated to the patients before the trail (0 for no pain and 100 for the most aggressive pain in life) and values other than zero was encountered pain appearance. Patients with signs of sedation were excluded.
Results: There was no statistically significant difference between patients in three groups in number of men and women (P = 0.66), age (P = 0.29) and weight (P = 0.49). Furthermore severity (P = differences (C = 41.18, L - 25.4 and M = 13.1, P < 0.001) and patients in metoclopromide group experiences lower pain than other two groups (P < 0.001). Pain incidence in Control group was 77.1% and it was significantly reduced in lidocaine and metoclopromide group (P = 0.002), but there were no significant difference between them (P = 0.051). The 0.69) and incidence (P ~ 0.29) of pain has no significant difference between men and women. Pain severity between three groups has significant results showed that metoclopromide could significantly reduce the seventy of pain on injection of propofol more than lidocaine (opposite to diazepam), but they had no difference in pain incidence. It might lie on the different mechanisms that they produce pain. Pain on injection of diazepam is primarily attributed to propylene glycol, as a vehicle, but the pain mechanism in propofol is remaining unknown.
Conclusion: Finally as regards to other useful effects of metoclopromide including postoperative nausea and vomiting and propofol induction dose reduction, especially when there is a medical condition where lidocaine is contraindicated, it may be a reasonable alternative before injection of propofol.

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Background: Metabolic syndrome is a complex of metabolic disorders that contemporary occurrence in a person is more than the risk of occurrence of each one separately. this syndrome has gained researcher's attention because of its relationship with cardiovascular disease and diabetes type II and its high prevalence in populations
Methods: A cross-sectional study performed on 1110 participants, 20-74 years old with cluster sampling. All of them had interview and special questionnaire were filled. Epidemiologic and demographic data were about hypertention cardio vascular disease and related lab data.
Results: The prevalence of metabolic syndrome was 32.1% that it was significantly more in women than men .this prevalence increased with age and BMI in both sexes .the most common metabolic disorder was TG>=150. 19.2% have none, 21.1% have one, 27.6% have two, 20.8% have three,9% have four and 2.3% have all criteria of metabolic syndrome.
Conclusion: Approximately one third of population of Yazd have metabolic syndrome and according to other statistics of Iran, this prevalence is more than U.S and Europe. It seems there is an urgent need for a national multicenter program for determinding risk factors for metabolic syndrome.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Macrosomia is a term applied to newborns with a birth weight of >4000g. This condition leads to several maternal and fetal complications including maternal traumas as well as newborn injury. This study was designed to evaluate the risk factors of macrosomia among Iranian women.
Methods: This cross-sectional study performed between July 2001 and July 2002, included 2000 term deliveries involving newborns with birth weights of >2500g. The records of 77 mothers of live born infants weighing >4000g were compared to those of the control group (231 women). Stillborn and neonates who were <2500g were excluded from the study.
Results: Among the 2000 deliveries performed in Imam Hospital, 77(3.8%) of the newborns weighed >4000g and 12(0.6%) weighed >4500g. The mean age of the mothers, maternal BMI, history of diabetes mellitus, multiparity, fetal sex and underling maternal disease were found to be associated with increase risk of fetal macrosomia. There was no significant relationship between prolonged gestation, weight gain more than 16kg during pregnancy and past history of macrosomic delivery and macrosomia.
Conclusions: It is possible to prevent macrosomia by weight and diabetes control before the decision to become pregnant. To prevent pregnancy among multipara mothers aged >35 years old, highly protective contraceptive methods should be used. Furthermore, if a mother is diagnosed with a macrosomic fetus by sonography or other imaging methods, more care should be taken during the delivery to decrease the risk of fetal injury, such as asphyxia and brachial plexus palsy.  

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Chlamydia trachomatis is a common and curable STI that may be symptomatic or asymptomatic. The few studies on C. trachomatis among Iranian women have had, for the most part, small sample sizes and are therefore unsuitable for epidemiological deductions. The aim of this study was to estimate the prevalence of urogenital C. trachomatis infections by PCR on urine samples of married women in their fertile years in order to determine the need for a C. trachomatis screening program for asymptomatic women in Iran.
Methods: This descriptive-analytical and cross-sectional study was performed on 991 married women. The research material consisted of questionnaires and urine samples, which were transported daily to Avesina Research Institute, Tehran, Iran, to extract their DNA and prepare them for PCR tests. The gathered data were analyzed by SPSS, version 13, and evaluated statistically by t-test, chi-square test, Fisher's exact test and logistic regression, considering p<0.05 as significant.
Results: Of all the subjects, 127 (12.8%) were positive by PCR for C. trachomatis. The mean age of the participants was 28.88± 6.19 years. Infection was more prevalent among those with lower levels of education, who were employed and not pregnant. This infection was more prevalent among those who were using contraception, especially condoms. Reproductive history revealed that infection was more prevalent among participants with a history of vaginal discharge, pelvic pain, infertility and low birth-weight infants, and less prevalent among those with a history of abortion, preterm delivery and ectopic pregnancy. However, these patterns were not statistically significant.
Conclusion: In populations with C. trachomatis prevalences higher than 4%, screening programs are recommended. Thus, Chlamydia screening should be part of the health care program in Iran to reduce the burden of this disease. 

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Background: Chronic Pelvic Pain (CPP), a common health problem in women, characterized by lower abdominal pain that has lasted at least for six months. Although, it's annual prevalence estimated 3.8 to 49%, there is no data in Iranian society. This study was aimed at gathering comprehensive and reliable data regarding the prevalence of CPP in female employees at two university hospitals in Tehran in 2006-2007.

Methods: A cross-Sectional study was conducted to determine the CPP prevalence on 303 volunteer females aged 19-63(34.7±9.2) years, working in two university hospitals, Tehran. A designed questionnaire with four parts containing questions regarding demographic information, gynecological, urinary and gastrointestinal symptoms was used. The ethical committee of the Shaheed Beheshti Medical University approved the study.

Results: The prevalence of present pelvic pain unrelated to menstrual cycle was 22.3% and totally 10.2% subjects suffered from CPP during the last 6-12 months. Our data showed a significant difference in prevalence of CPP between women with and without vaginal delivery (37% VS. 24 P=0.036%). There was a significant relationship between incomplete and hard defecation and occurrence of CPP (p<0.001). The prevalence of LBP & PPD in women with CPP was higher than women with no CPP (p<0.001).

Conclusions: Regarding to the prevalence of CPP and its relationship with gynecological, urinary, musculoskeletal and gastrointestinal factors, we emphasize on a multidisciplinary approach for management of CPP, also recommend performing further community-based epidemiological studies.

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Background: Osteoarthritis is the most common form of arthritis in the world. This study presents the evidence on the prevalence of symptomatic hand osteoarthritis in urban community. To add to the evidence on the prevalence of symptomatic hand osteoarthritis in urban community.
Methods: Inhabitants (age≥15 yrs) in 22 randomly selected districts (Tehran) participated in a Community-Oriented Program for Control of Rheumatic Diseases (COPCORD) evaluating major rheumatic disorders, including osteoarthritis. Eventually, 10, 291 inhabitants completed a Questionnaire (75% response-rate). Trained interviewers asked participants whether they had had any pain, swelling, tenderness, or morning stiffness in the right/ left hand during previous seven days. Participants underwent a complete physical examination if they had any musculoskeletal complaint or extra-articular manifestation of rheumatic disease. Osteoarthritis was defined as presence of palpable nodules (Heberden’s/ Bouchard’s nodes, CMC1’s squaring), pain, tenderness, swelling, or a combination of them on that joint (DIP-PIP-MCP-CMC1). Clinical hand osteoarthritis was positive if at least one joint showed osteoarthritis.
Results: Symptomatic hand osteoarthritis was present in 2.8%(CI 2.3-3.4) (52.6% female, mean age 37.1±16.3). Prevalence was higher in females (4.3% vs. 1.3%, p=0.000) and increased with age (0.1% in people <30 versus 23% in people >70, p=0.000). The most common signs in the DIP, PIP and CMC1 joints were bony enlargement, followed by tenderness and pain on movement.
Conclusions: our study confirms the evidence of high prevalence of symptomatic hand osteoarthritis in an urban community. The prevalence, pattern of hand joints involvement and relationship with age and sex in this study performed in an Eastern community resemble those in Westerners, which calls for further attention by appropriate services.

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Background: Prevalence of Abdominal Aortic Aneurysm (AAA), estimated by various studies, ranged from 4.1% to 14.2% in men older than 60 years. Most cases of AAA are asymptomatic and often discovered incidentally. Approximately the initial presentation in 12% of cases of AAA is sudden rupture with subsequent high mortality. This study was performed to evaluate the prevalence and screening necessity of AAA among Iranian men older than 65 years old.

Methods: In this cross-sectional study, men older than 65 years, who referred for ultrasound examination to three different centers in Tehran, Iran at the year 2008 were included for evaluation of size of the abdominal aorta and presence of AAA.

Results: A total of 240 men older than 65 years enrolled in this study. AAA was found in 24 of the participants with prevalence rate of 10% in the studied population. Mean diameter of detected aneurysms was 3.931.435 cm. In 4 (1.7%) subjects, aneurysms greater than 5.5 cm in diameter were detected. One of these four subjects had the history of coronary artery disease and one was cigarette smoker. Three out of four had history of hypertension.

Conclusion: Considering the estimated prevalence rate of AAA by the current study and the population of Iranian men older than 65, implementing of mass screening for AAA in this group would detect 986 asymptomatic cases each year. Therefore, the authors recommend further studies about the cost-effectiveness of mass screening for AAA among Iranian men above 65 years.

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Background: Body dysmorphic disorder (BDD) is characterized by a preoccupation with an imagined defect in ones appearance or an exaggeration of a slight physical anomaly. Any part of the appearance may be the focuse of BDD patients. Thus preoccupation with appearance leads to significant damages of social and job functioning. The aim of this study is to determine the prevalence of BDD in patients referred to cosmetic clinic of Razi hospital.
Methods: Patients visiting cosmetic clinic of Razi hospital were selected if they agreed to participate in the study. They were evaluated by Yale brown obsessive compulsive scale modified for body dysmorphic disorder (YBOCS-BDD) as well as questionnaires containing demographic characteristics of patients including gender, educational status, marital status, history of reference to psychiatrist or psychologist, other medication, history of cosmetic surgery and rate of satisfaction of cosmetic surgery. YBOCS-BDD questionnaires then processed by educated specialist to determine BDD score of patie-nts. Demographic questionnaires, also analysed to evaluate epidemiologic properties of patients visiting cosmetic clinic of Razi hospital.
Results: The prevalence of BDD in current sample was 33.3%. 70.7% of BDD patients were female while 29.3% were male. The commonest age range was 21-50 years (82.8%). 65.5% were educated to level of diploma or lower, while 34.5% had academic degrees. 51.7% were married. 20.7% had history of reference to psychiatrist or psycholo-gist. 17/2% had history of cosmetic surgery with satisfaction ranging from unsatisfied (20%) to relative satisfaction (80%). None were fully satisfied.
Conclusion: BDD had high prevalence in patients visiting cosmetic clinic of Razi skin hospital. This high rate of prevalence show the necessity of diagnosis of BDD in skin patients and it is critical for them to refer to psychiatrists or psychologists.

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Background: Although sexual dysfunction is a common problem in patients with obsessive-compulsive disorder (OCD), there are sparse clinical research on the study of the correlation between OCD subtypes and different phases of sexual response cycle. This study was undertaken to assess sexual function and its different phases in a group of Iranian patients with OCD. Methods: This was a descriptive cross-sectional study. The subjects consisted of 56 married OCD patients (36 female, 20 male) who suffered from OCD according to a psychiatric interview and DSM-IV questionnaire based on structured clinical interview for DSM (SCID). Patients were between 18 to 50 year age that had been referred to the outpatient clinic of Roozbeh Psychiatric Hospital and three private psychiatric clinics in Tehran (from September 2011 to February 2013). Five Questionnaires were used in this study: Iranian validated form of Female Sexual Function Index (FSFI), International Index of Erectile Function (IIEF), Maudsley Obsessional Compulsive Inventory (MOCI), Obsessive Compulsive Inventory-Revised (OCI-R) and a questionnaire which has provided demographic data and other relevant information regarding sexual function and OCD. Results: The prevalence of sexual dysfunction among female was 80.6% and the frequency of disorders in different subscales of FSFI including sexual desire, sexual arousal, lubrication, orgasm, satisfaction and sexual pain were 50%, 58.3%, 36.1%, 44.4%, 41.7% and 52.8% respectively. Sexual disorder is reported in 25% of male OCD patients which subscales' evaluation of IIEF shows low sexual desire in 10%, erectile disorder in 20%, orgasmic disorder in 25%, sexual dissatisfaction in 40% and 50% decreased in the total sore of IIEF. Moreover, the correlation coefficients between the total score of OCI-R with erectile and satisfaction subscales of IIEF were statistically significant. The score of washing subscale in OCI-R and sexual satisfaction was significantly correlated. Conclusion: High prevalence of sexual dysfunction in OCD women and significant correlation between male sexual dysfunction and OCD (r= -481.0 between total score of OCI-R with erectile dysfunction and r= -458.0 between total score of OCI-R and sexual satisfaction) could confirm a relation between OCD and sexual disorders. So, evaluation of sexual function in all patients with OCD is recommended.

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Background: Diabetic foot infections a common complication of diabetes. Staphylococcus aureus is most common pathogen associated with diabetic foot infection. Frequency of methicillin-resistant Staphylococcus aureus (MRSA) associated with diabetic foot infection at other country is 15-30% and important cause at hospital acquired infection. The aim of this study was to evaluate the prevalence of pathogenic organisms and the prevalence and contributing factors of MRSA in patients with diabetic foot infection. Methods: A cross-sectional study from 70 diabetic foot infection at Imam Khomeini Hospital, Tehran, Iran from March 2013 to September 2014. A retrospective analysis of wound swabs taken from infected foot ulcers in diabetic patient, selected from an outpatient diabetic foot. Swabs were used to obtain tissue fluid from the base after debriding the ulcer with a sterile scalpel. Sixty patients with positive wound swabs were included. Size of ulcer and ulcer grade were measured in all patients. Results: A total of 61 microorganisms were isolated. The mean number of isolate was 0/87. Corynebacterium spp were the sole pathogen in three cases than taked into normal flora. There wasn’t significant P-value between demographic subjects and MRSA frequency. In this study, P= 0/05, CI:95% were considered statistically significant. Gram-positive aerobic bacteria were the most common micro-organism isolated (52.54%) followed by gram-negative aerobic bacteria (44.26%). among the gram-positive aerobic organisms, Staphylococcus aureus was found most frequently and 10% were MRSA that confirmed by E-test. There wasn’t significantly different in measurement of the MRSA positive patients compared to MRSA negative patients (P> 0.05). Conclusion: In this study, MRSA prevalence was similar to other Asian studies and different from west countries study. There wasn't significant difference between gram-positive and gram-negative microorganisms that look out to change of microbiological profile in diabetic foot infections and creation multi-drug resistant bacteria. MRSA infections and other multi drug resistant organisms is a serious problem and increasing problem in diabetic foot infections. Further studies are required to assess the need for antibiotics in treating foot ulcers in diabetes and to assess the optimal therapeutic management.

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Background: Chronic obstructive pulmonary disease (COPD) and heart failure are prevalent comorbidities affecting a vast proportion of the world population, responsible for significant morbidity and mortality, their coexistence is more frequent than previously recognized that poses important diagnostic and therapeutic challenges. We intend to determine the prevalence of concomitant left ventricular dysfunction in COPD patients. Methods: We performed a cross-sectional study in patients who had referred to Firuzgar University Hospital in Tehran from March 2011 to March 2013 in period of 2 years. All participants were compatible for including and excluding criteria’s. In all cases of COPD, pulmonary function test was done also Echocardiography was performed as the diagnostic assessment of heart failure. Results: Out of 74 participants there was 56(75.7%) male and 18(24.3%) female with the mean age of 67.712.9 (SD), the prevalence of left ventricular systolic dysfunction (LVSD) was 25.70%, also the prevalence of left ventricular diastolic dysfunction (LVDD) was 74.60% among 71 patients. The prevalence of LVSD in patients with and without history of coronary artery disease (CAD) was 33.30% and 15.60% respectively. The prevalence of LVDD was 85.40% in patient with history of CAD and 60% in patients without it. The presence of ventricular dysfunction (neither systolic nor diastolic) in COPD patients was not statistically associated with presence of CAD or the intensity of underlying COPD disease. Conclusion: Knowledge about the prevalence of concomitant left side heart failure in COPD patients is limited, but it seems the presence is rather common, so more attention should be paid to coexistence of ventricular dysfunction in COPD patients disregarding presence of CAD or COPD intensity in clinical practice.

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Background: Smoking is known as the most important preventable risk factor for morbidity and premature death. It is the fourth risk factor attributable to burden of disease globally. Because of the misconception that waterpipe is less harmless than cigarette and also less socially prohibited, people smoke waterpipe more. Studies showed that tobacco consumption rate is increasing among adolescents and it`s initiation age has been declined. The aim of current study was the assessment of the prevalence of different types of tobacco use among students aged between 14 to 18 year old in Tehran. Also we had a comparison with similar studies. Methods: In this cross-sectional study 2877 students between May and July 2014 have been assessed. Samples were collected from language institutes and “Farhangsara”s according to stratified cluster sampling based on the educational zones in Tehran. A structured questionnaire was used for different types of tobacco use habit assessment. Because of sampling method, data analysis was done with complex sample survey analysis in SPSS, ver. 20 (Chicago, IL, USA) and Stata, ver. 12 (College Station, TX, USA) software. P-values less than 0.05 considered as statistically significance. Results: Among participants 11.5% (10.8%-13.3%) had cigarette smoking experience. The prevalence of current cigarette smoking was 4.4% (3.7%-5.3%). 1.4% (0.9%-2.2%) of girls and 7% (5.7%-8.5%) of boys were current cigarette smokers (P< 0.001). Waterpipe smoking experience prevalence was 41.5% (39.7%-43.4%) in total, 41.7% (39.2%-44.2%) in girls and 41.4% (39.2%-44.2%) in boys. Current waterpipe smoking was reported in 25.7% (24.1%-27.4%) of students with no statistically significant difference between boys and girls. Pipe smoking experience prevalence was 3.9% (3.2%-4.7%) and it was more frequent in boys. Conclusion: Cigarette smoking was significantly higher among boys than girls, while waterpipe smoking prevalence showed no difference. In addition, smoking prevalence was higher among students who had smoker parents or smoker friends and also had a bad economic status. It seems that specific interventions should be considered to reduce tobacco burden in adolescents specially in regard to cigarette and waterpipe smoking.

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Background: Hypertension is one of the most important chronic illness worldwide and one the major risk factors for cardiovascular diseases. Obesity and abdominal obesity are risk factors for high blood pressure. Population attributable fraction (PAF) answers the question of how much of the disease burden in a certain population may be reduced if a risk factor like obesity is removed from the population. It implies that reducing prevalence of obesity as a risk factor of hypertension, may reduce the burden of hypertension and its consequences. The aim of this study was to determine the population attributable fraction of hypertension associated with obesity, abdominal obesity and joint effect of them in the men of Mazandaran Province, North of Iran.

Methods: In this epidemiological study, the data of non-communicable disease surveillance system in 2009 has been achieved. Then measure of association between obesity and hypertension (Odds Ratio) was extracted from Tehran Lipid and Glucose Study (TLGS). After standardizing the data, the population attributable risk for men based on the above formula (Levin's attributable fraction formula) has been calculated.

Results: In our study based on population attributable fraction, results in blood pressure caused by obesity were 14.5 (CI 95%: 10.7-17.2), the effect of abdominal obesity was 7.4 (CI 95%: 2.04-11.3) and deductions attributable joint effect both obesity and abdominal obesity was 22.6 (CI 95%: 9.7-25.6) respectively. Conclusion: Given the high prevalence of hypertension and obesity in Mazandaran men and the impact of obesity on blood pressure is necessary to prevent the spread of the disease. It is recommended that health promotion programs focus on men with high blood pressure due to obesity could be performed.

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Results: In a survey of 33 studies and 97205 participants in the age range of (3-18) years, the general prevalence of asthma in this study based on meta-analysis was 5.1% (CI95%: 4-6.5%). The highest prevalence of asthma was among children from Babol which was 19% (CI95%: 17.8% -20.3%) in 2014 and the lowest prevalence of asthma was among children from Isfahan with 0.7% of prevalence (CI95%: 0.5-1.1) in 2001. Also, with the increase of research years and overall sample size in each study, asthma in children shows increasing and decreasing levels, respectively; and the differences were statistically significant. Conclusion: Based on what was reported in this study, the prevalence of asthma among Iranian children is lower compared to children of developed countries.

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