Microsporidiosis in Iran:A systematic review and meta-analysis

Objective:To examine all evidences about Microspondia infection in vertebrate/invertebrate hosts and Iranian populations distributed in different regions of the country.Methods:All published articles up to December 2015,including descriptive and cross-sectional studies related to the prevalence and genotyping of Microspondia infection in Iran,was considered in this systematic review.The meta-analysis was done using the random-effects model and Stats Direct statistical software.MEGA 5.05 software and maximum likelihood algorithm with Kimura 2-parameter model were used for phylogenetic analysis.Results:Of the 1 152 investigated studies,33 eligible studies reported a prevalence of Microspondia infection in vertebrate and invertebrate hosts.According to this systematic review,the overall prevalence rate of Microsporidia infection in immunocompromised patients in Iran was 8.18%.Furthermore,the overall prevalence rate of Microsporidia infection in immunocompromised patients with chronic diarrhoea,patients with non-diarrhoea,gastroenteritis,and patients with CD4(< 200 cells/μL) was 15.4%,4.1%,0.5%,and 12.9%respectively.The highest prevalence rate of human and animal Microsporidia was estimated in Kerman(29%) and Khuzestan(26.5%).The overall prevalence rate of Microsporidia infection in honeybees using the random-effects model was 40%.Furthermore,the highest prevalence rate of nosemosis was described in East Azerbaijan(48.2%).The maximum number of Microsporidia isolates from immunocompromised patients and pigeons in Iran belonged to genotypes D(n=16;50%) and E(n=6;20.6%) of Enterocytozoon bieneusi.Conclusions:This study may be the first systematic review and meta-analysis that provides a broad outlook on the prevalence of microsporidiosis in Iran.It is necessary to investigate Microsporidia infection in vertebrate and invertebrate hosts and environmental resources in Iran.

Open visitation in the NICU:nurses’perspectives on barriers and facilitators

Objective:This study aimed to investigate the nurses’perspectives on open family visitation and its barriers and facilitators in neonatal intensive care units(NICUs).Methods:This is a descriptive,cross-sectional study.A total of 113 nurses employed in 3 main NICUs of Tabriz participated in the study through the census sampling method.Nurses’perspectives on open visitation and its facilitators and barriers were assessed and analyzed using the Beliefs and Attitudes toward Visitation in NICU Questionnaire(BAVNIQ)and descriptive and analytical statistics,respectively.Results:Approximately 74%of the nurses who participating in the study had a moderate perspective on open visitation.From the nurses’viewpoint,“Parents’low awareness of sensitivity and hygienic principles of the NICU”was the first(90.3%)barrier,and the 2 factors,namely,“physical structure of the ward/lack of sufficient space”and“far distance between family’s residence and the hospital/having another child,”were the second(86.8%)barrier with an equal percentage.Among the facilitating factors,“Supporting employed parents during the neonate’s hospitalization”and“providing facilities for family accommodation in the hospital”were the first(82.3%)and the second(79.6%)facilitators,respectively,for open visitation.Conclusions:The majority of NICU nurses had a moderate perspective on the family open visitation.This reluctance seems to be originated mainly from the factors inhibiting open visitation,making its implementation challenging for nurses.The perspective of the frontline staff in caring for vulnerable infants on facilitators and barriers to open visitation may help policymakers,managers,and relevant officials in decision-making and implementing new visiting policies in the NICUs.

Thyroid autoimmunity at the onset of type 1 diabetes mellitus in children

Introduction: Studies that have investigated autoimmune thyroid disease in newly diagnosed type 1 diabetic children are few and reported prevalence rate ranges between 4.5 - 29.4 percent. Considering the effect of age, ethnic origin, and disease duration on the prevalence of autoimmune thyroid disease in diabetic subjects, we decided to investigate the thyroid autoimmunity in newly diagnosed type 1 diabetic children in our area of residence (North-WestIran). Methods: This cross-sectional study was carried out between 2008 and 2010. All of the children with newly diagnosed type 1 diabetes mellitus (T1DM) presenting to the outpatient pediatric- endocrinology clinic of Tabriz University of Medical Sciences (the only university-affiliated clinic for pediatric-endocrinology in North-west Iran), were investigated for serum levels of anti- TPO, anti-Tg and TSH. Results: The study group included 99 children [mean age 7.75 ± 3.21 years (range 1.2 - 14), 45 boys (45.5%) and 54 girls (54.5%)]. About 9% of patients were seropositive for anti thyroid antibodies and females were affected more than males. The mean TSH level of subjects above 12 years of age (3.5 ± 2) was significantly (p = 0.037) higher than those below this age. Conclusion: Autoimmune thyroid disease and even hypothyroidism may accompany T1DM at its presenting time in children. This finding is more common in girls especially those above 12 years of age.

Effect of vitamin D treatment in children with attention-deficit hyperactivity disorder

Background In this research the symptom improvement of attention-deficit hyperactivity disorder (ADHD) of children was assessed by oral vitamin D administration in Tabriz,Iran.Methods In this double-blind,randomized clinical trials,96 children (2-18 years) were enrolled to placebo and vitamin D groups.Children took vitamin D pearl (50,000 IU/week) or placebo for 6 weeks.Children,who had the change in methylphenidate dosage and received any anticonvulsants and corticosteroids were excluded from the research.ADHD symptoms were diagnosed by Conners parent rating scale (CPRS) test at baseline and after intervention.ADHD Conners divided into inattention (IA),hyperactivity/impulsivity (H/I) and combination type (C) subscales.Vitamin D serum level was assessed at baseline and after 8 weeks in both groups.Results The differences between CPRS and its subscales were not significant at baseline (P > 0.05).The Conners IA score was decreased in vitamin D group (P < 0.05;adjusted with age and baseline values).ADHD Conners and all subscale scores reduced remarkably after intervention in patients with insufficient level of vitamin D compared to placebo (P < 0.05).Conclusions Oral vitamin D improved ADHD symptoms with a particular effect on inattention symptoms.In addition,symptoms related to all subscales were improved remarkably in patients with insufficient level of vitamin D.Vitamin D treatment in children with ADHD could be considered due to the expand benefit of vitamin D in body.