Showing papers in "Archives of Iranian Medicine in 2007"

Phase 1 trial of autologous bone marrow mesenchymal stem cell transplantation in patients with decompensated liver cirrhosis

Abstract: Background: The standard treatment for decompensated liver cirrhosis is liver transplantation. However, it has several limitations. Recent animal studies suggest that bone marrow stem cell transplantation can lead to regression of liver fibrosis. The objective of this study was to determine the safety and feasibility of autologous bone marrow-mesenchymal stem cell transplantation in patients with decompensated liver cirrhosis. Methods: In this phase 1 trial, four patients with decompensated liver cirrhosis were included. Their bone marrow was aspirated, mesenchymal stem cells were cultured, and a mean 31.73×10 6 mesenchymal stem cells were infused through a peripheral vein. Primary outcomes were evaluating the safety and feasibility of the work. Secondary outcomes were evaluating changes in the model for end-stage liver disease score, and the quality of life of the patients. Results: There were no side-effects in the patients during follow-up. The model for end-stage liver disease scores of patients 1, and 4 improved by four and three points, respectively by the end of follow-up. Furthermore, the quality of life of all four patients improved by the end of follow-up. Using SF-36 questionnaire, the mean physical component scale increased from 31.44 to 65.19, and the mean mental component scale increased from 36.32 to 65.55. Conclusion: Mesenchymal stem cell transplantation seems to be feasible and safe in the treatment of decompensated liver cirrhosis.

Esophageal cancer in Northeastern Iran: a review.

Abstract: Golestan Province in northeastern Iran has one of the highest rates of esophageal squamous cell cancer in the world. This article reviews the studies conducted on esophageal squamous cell cancer in this area and summarizes the data on epidemiologic patterns, incidence trends, and etiology of esophageal squamous cell cancer in this province.

Crimean-Congo hemorrhagic fever.

Abstract: Crimean-Congo hemorrhagic fever is a tick-borne viral disease reported from more than 30 countries in Africa, Asia, South-East Europe, and the Middle East. The majority of human cases are workers in livestock industry, agriculture, slaughterhouses, and veterinary practice. Nosocomial transmission is also well described. Clinical manifestations are nonspecific and symptoms typically include high fever, headache, malaise, arthralgia, myalgia, nausea, abdominal pain, and nonbloody diarrhea. Patients may show signs of progressive hemorrhagic diathesis. Laboratory abnormalities may include anemia, leukopenia, thrombocytopenia, increased AST/ALT levels, and prolonged prothrombin, bleeding, and activated partial thromboplastin times. Diagnostic methods include antibody detection by enzyme-linked immunosorbent assay, virus isolation, antigen detection, and polymerase chain reaction. The mainstay of treatment of Crimean-Congo hemorrhagic fever is supportive, with careful maintenance of fluid and electrolyte balance, circulatory volume, and blood pressure. The Crimean-Congo hemorrhagic fever virus is susceptible to ribavirin in vitro. There is no controlled study evaluating oral versus intravenous ribavirin in treating Crimean-Congo hemorrhagic fever patients, but few studies have evaluated oral ribavirin. This article reviews the epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment, prevention, and prognosis of Crimean-Congo hemorrhagic fever with a special focus on oral ribavirin as a choice of medical treatment.

Q-angle: an invaluable parameter for evaluation of anterior knee pain

Abstract: Background: Patellofemoral pain syndrome is a descriptive term applied to patients with nonspecific anterior knee pain, and is the most common knee problem. The pain in most patellofemoral disorders is generalized to the anterior part of the knee. One important concept in patellofemoral joint function is the quadriceps angle (Q-angle). Theoretically, a higher Q-angle increases the lateral pull of the quadriceps femoris muscle on the patella and potentiates patellofemoral disorders. This study was undertaken to evaluate the relationship between the anterior knee pain and Q-angle. Methods: This prospective study was performed on two groups; the case group consisted of 100 outpatients (44 men, and 56 women) aged between 15 and 35 years, with anterior knee pain. The control group consisted of 100 outpatients (50 men, and 50 women) with the same age distribution, who presented with different problems in the upper extremities and no knee problems. The Q-angle of each knee was measured in all participants, using a universal goniometer. Results: The mean Q-angle for men, women, and all participants in the case group was 15.2, 20.1, and 18.0 degrees, respectively. In the normal control group the angles were 12.1, 16.7, and 14.9 degrees, respectively. All these differences were statistically significant (P < 0.001). Conclusion: These results substantiate the fact that patients with anterior knee pain have larger Q-angles than healthy individuals.

Autologous In Vitro Expanded Mesenchymal Stem Cell Therapy for Human Old Myocardial Infarction

Abstract: Background: Stem cell transplantation after myocardial infarction has been claimed to restore cardiac function. Mesenchymal stem cells attract a lot of attention because of the feasibility of in vivo and ex vivo differentiation to cardiomyocytes and endothelial cells as well as their trophic effect on tissue repair. In this study, we investigated the efficacy of autologous bone marrow derived mesenchymal stem cells in improving heart function in patients with old myocardial infarction. Methods: Eight patients with old myocardial infarction and proper inclusion criteria were injected with mesenchymal stem cells at the time of coronary artery bypass grafting or percutaneous coronary intervention (test group) and compared with eight matched patients who received the same treatment without mesenchymal stem cell injection (control group). Evaluation of heart function was done by echocardiography plus single-photon emission computed tomography before and six months after the procedure. Serial clinical examination was performed every month through New York Heart Association class. Results: The mean New York Heart Association class and single-photon emission computed tomography scan results decreased significantly in the test group (P=0.000 and 0.002, respectively) and in the control group (P=0.049 and 0.007, respectively) after the procedure at six months followup. Left ventricular ejection fraction increased significantly in the test group (P= 0.005) but not in the control group. In comparison between the test and control groups the results of New York Heart Association class assessment and single-photon emission computed tomography demonstrated significant improvement in the test group (P=0.005 and 0.013, respectively). There were no significant differences between the baseline variables in the two groups. Conclusion: Transplantation of ex vivo expanded bone marrow derived mesenchymal stem cell in patients with old myocardial infarction is a safe and feasible procedure. These cells improve the cardiac function without serious adverse effects.

Survival rate of gastric and esophageal cancers in Ardabil province, North-West of Iran.

Abstract: Background: Upper gastrointestinal cancer is the most common cancer in Ardabil Province, North-West of Iran, accounting for more than 50% of all cancer deaths in this area. We conducted this study to determine the present survival rate of patients with esophageal and gastric cancers before launching interventional studies. Methods: A prospective follow-up study of 420 biopsy-proven patients (127 females, mean age: 64) with upper gastrointestinal cancer (141 esophageal and 279 stomach cancers) who were initially diagnosed in Aras Clinic, the main gastrointestinal referral center of Ardabil Province, from 2000 through 2004, was performed with collection of data on demographics, tumor characteristics, pathologic stage, treatment methods, complications, survival time, etc. Data were gathered through direct interview with patients or their families in 303 cases and evaluation of death certificates in 55 patients. Follow-up was from cancer diagnosis until death, or immigration. Survival according to stage of disease, Lauren tumor type, tumor location, surgery, and adjuvant chemotherapy was analyzed, and results were compared with those of western series. Results: Sixty-two cases were lost to follow-up. The one- and five-year survival rates in the patients with upper gastrointestinal cancer in Ardabil Province were 40.5%, and 0.8%, respectively. In the univariate analysis, men had a slightly lower survival rate than women (P = 0.21) and patients with esophageal cancer had a longer survival rate compared to stomach cancer patients (P = 0.15). Patients who had undergone surgery (P < 0.001) and/or chemotherapy (P < 0.001) survived longer than those without such treatments. Tumor morphology, age at diagnosis, radiotherapy, alcohol, and opium consumption did not show any significant effects on the survival rate of patients. In multivariate analysis, only smoking was remained as an independent factor for stomach cancer (P = 0.04) while in esophageal cancer, surgery and grade of differentiation were significant predictors of survival. Conclusion: Survival rate of stomach and esophagus cancer cases in Ardabil is relatively low. Intervention for early detection and therapy is necessary to increase survival.

The incidence of prostate cancer in Iran: results of a population-based cancer registry.

Abstract: Background: Little is known about the epidemiology of prostate cancer in Iranian men. We carried out an active prostate cancer surveillance program in five provinces of Iran. Methods: Data used in this study were obtained from population-based cancer registries between 1996 and 2000. Results: The age-standardized incidence rate of prostate carcinoma in the five provinces was 5.1 per 100,000 person-years. No significant difference was seen in the age-standardized incidence rate of prostate cancer within the provinces studied. The mean±SD age of patients with prostate cancer was 67±13.5 years. Conclusion: The incidence of prostate cancer in Iran is very low as compared to the Western countries. This can partly be explained by lack of nationwide screening program, younger age structure and quality of cancer registration system in Iran. Archives of Iranian Medicine, Volume 10, Number 4, 2007: 481 – 485.

Epidemiology of gastroesophageal reflux symptoms in Tehran, Iran: a population-based telephone survey.

Abstract: Background: The prevalence of gastroesophageal reflux disease (GERD) in Asian populations is reported to be lower than that in the West. Population-based data on the prevalence and symptom profile of GERD in developing Caucasian countries is lacking. Our objective was to determine the prevalence of gastrointestinal symptoms and clinical spectrum of GERD in Tehran, northern Iran and their association with patient characteristics. Methods: One thousand seven hundred telephone numbers were randomly selected from Tehran telephone directory using a simple random method. A two-step screening telephone survey was then performed. In each answered call a second rapid survey was done to select a subject 18 – 65 years old from that household. A validated questionnaire was then filled out for that individual. Patient characteristics (age, education, and gender) and history of acid regurgitation and heartburn during the last week, as well as the previous three months were inquired about. Results: Of the 1,700 selected numbers, 278 either did not answer or did not have an eligible case; 220 refused to participate. A total of 1,202 subjects (42% males, mean age: 36 years, range: 18 – 65 yr) were surveyed. The prevalence of heartburn occurring monthly, weekly, and daily was 4.7% (CI95%: 3.5 – 6.0%), 1.6% (CI95%: 1.0 – 2.5%), and 0.6% (CI95%: 0.3 – 1.3%), respectively. The corresponding figures for acid regurgitation were 15.6% (CI95%: 13.6 – 17.7%), 5.7% (CI95%: 4.4 – 7.1%) and 1.5% (CI95%: 0.9 – 2.4%), respectively. The prevalence of GERD, defined as heartburn and/or acid regurgitation experienced daily, weekly and monthly was 1.9% (CI95%: 1.2 – 2.9%), 6.8% (CI95%: 5.4 – 8.3%), and 18.4% (CI95%: 16.2 – 20.6%). There was no relationship between the prevalence of GERD and either gender, age, or education. Conclusion: Monthly GERD symptoms occur in 18.4% of the general population in Tehran. Acid regurgitation is more common (4 – 5 times) than heartburn. Gender, age, and level of education do not affect the prevalence of GERD symptoms in the community studied.

Snoring and obstructive sleep apnea.

Abstract: The number of patients who suffer from snoring and sleep apnea in Iran has been increasing in proportionate to the rest of the world as the prevalence of obesity has soared within the last two decades. This pandemic obesity is blamed on consumption of more energy-dense, nutrient-poor foods with high levels of sugar and saturated fats. Obesity is one of the major contributing factors of obstructive sleep apnea. The number of people snoring in Iran is not well established, but since many years ago this bizarre behaviour was looked upon as an annoying sound that some people have and it was thought that they have to live with it. It was not until early twentieth century that scientists began to relate an association between snoring, obesity, and sleep-related disorders. At present time, it is well documented and universally agreed that snoring as well as sleep apnea are far more prevalent in societies and can lead to other serious illnesses including heart attack, stroke, and even nocturnal death. Obstructive sleep apnea is a term used to describe cession of breathing while sleep for a period of 10 seconds or more and repeated over five times per hour of sleep. In this article, we review various methods of surgical treatments and the long-term relapse potential for each.

The prevalence of complicated grief among Bam earthquake survivors in Iran.

Abstract: Earthquake is a natural disaster, which causes many psychological problems in survivors. Complicated grief is one of these sequelae. A devastating earthquake with a magnitude of 6.3 on the Richter scale destroyed the city of Bam in Kerman Province, Iran. Twenty-six thousand people were killed. Many of the survivors should have developed psychological problems in the aftermath of the disaster. In this study, we examined the prevalence of complicated grief and its correlation with the demographic factors and some suggested contributing variables. In this cross-sectional study, 400 persons were selected by stratified multistage area sampling. The survivors were interviewed in their temporary residential camp. After evaluating their demographic data, they were evaluated with the inventory of complicated grief. The cut-off point was set to 25. The mean±SD age of the participants was 37.8±12.7 years. Complicated grief was detected in 304 (76%) of the respondents. Score of complicated grief was higher among women and in those with lower educational levels. Presence in the city during the earthquake, observing burial of corpses, destruction of residential homes during the earthquake, residential problem after the catastrophe, and loss of at least one of the first relatives during previous earthquakes were variables which were correlated with the complicated grief. Existence of complicated grief in more than two-thirds of respondents requires more attention of mental health services. Rebuilding of homes and solving the residential problems of survivors are the factors, which could help survivors to find their mental health within a shorter period.

Domestic violence against women attending gynecologic outpatient clinics.

Abstract: Background: Violence against women and threat of violence are some of the main barriers to women’s empowerment and equal participation in the society. However, they often go unnoticed and undocumented and therefore unresolved. For women, one of every five years of healthy life lost because of injury, disease, or premature death is attributable to violence. The aim of this study was to identify the prevalence of domestic violence in women attending three obstetric and gynecologic clinics in Tehran, and to determine the association between domestic violence and demographic factors. Methods: One thousand women, 15 – 64 years old, attending three obstetric and gynecologic clinics affiliated to Iran University of Medical Sciences in Tehran were invited to participate in a cross-sectional survey with self-administered questionnaire. The association between demographic factors (age, level of education, religious believes, annual income, job, husband’s employment status, drug and alcohol abuse, previous custody of husbands) and domestic violence was assessed by questionnaire. Results: Five hundred and ninety out of the 1000 women had experienced at least one form of violence (physical, mental, not sexual) from their husbands, 196 women had experienced some forms of controlling behavior and mental violence, and 361 women had been physically threatened. Low level of education in women, nongovernmental job, previous custody, psychiatric disorders of men, and coercive marriage for women were associated with an increased risk of domestic violence. Conclusion: With the high prevalence of domestic violence, health workers should not ignore the seriousness of domestic violence. Health and social personnel should be appropriately trained before “asking all cases” becomes a policy within health and social services.

Religious and cultural traits in HIV/AIDS epidemics in sub-Saharan Africa.

Abstract: Background: The pandemic of HIV/AIDS in sub-Saharan Africa and the rise of epidemics in Asia to the previously unforeseen level are likely to have global social, economic, and political impacts. In this emergency, it is vital to reappraise the weight of powerful religious and cultural factors in spreading the disease. The role of Islam in shaping values, norms, and public policies in North African states is to be appreciated for the lowest HIV prevalence in their populations. Yet, the place of religion in prevention of the disease diffusion is not fully understood nor worldwide acknowledged by the primary decision makers. Another topic, which has received little attention to date, despite the abundance of literature concerning the unfortunate Africa’s anti-AIDS campaign, is an issue of colonial past. Methods: To better comprehend the share of both traits in diverse spread of HIV in subSaharan Africa, we studied the correlation between Muslim and Christian proportions in the state’s population and HIV rate. Results: By this method, Muslim percentage came out as a potential predictor of HIV prevalence in a given state. In another approach, most subcontinental countries were clustered by colocalization and similarity in their leading religion, colonial past, and HIV seroprevalence starting from barely noticeable (0.6 – 1.2%, for Mauritania, Senegal, Somalia, and Niger) and low levels (1.9 – 4.8%, for Mali, Eritrea, Djibouti, Guinea, Guinea-Bissau, Burkina-Faso, and Chad) for Muslim populated past possessions of France and Italy, in the northern part of the subcontinent. Former territories of France, Belgium, Portugal, and the UK formed two other groups of the countries nearing the equator with Catholic prevailing (Democratic Republic of Congo, Republic of Congo, Rwanda, Gabon, and Burundi) or mixed populations comprising Christian, Muslim, and indigenous believers (Benin, Ghana, Uganda, Togo, Angola, Nigeria, Liberia, Kenya, Cameroon, Cote d'Ivoire, and Sierra-Leone), which covered the HIV prevalence range from 1.9% to 7%. Albeit being traced by origin to the central part of the continent, HIV has reached the highest rates in the South, particularly Malawi (14.2%), Zambia (16.5%), South Africa (21.5%), Zimbabwe (24.6%), Lesotho (28.9%), Botswana (37.3%), and Swaziland (38.8%)—all former British colonies with dominating Christian population. Conclusion: In the group ranking list, a distinct North to South oriented incline in HIV rates related to prevailing religion and previous colonial history of the country was found, endorsing the preventive role of the Islam against rising HIV and the increased vulnerability to menace in states with particular colonial record.

The prevalence of attention deficit hyperactivity disorder in preschool-age children in Mashhad, north-East of Iran.

Abstract: Background: Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood-onset psychiatric disorders. Although the onset of ADHD is frequently prior to the age of seven years, there is a paucity of data on the prevalence of the disorder in preschool-age children. This study was performed to determine the prevalence rate of ADHD in preschool-age children in kindergartens of Mashhad, North-East of Iran. Methods: One thousand eighty-three (553 males and 530 females) children aged between five and six years, were selected at random from 155 kindergartens in ten districts of Mashhad. The ten-item Conner’s Index questionnaire was completed for each child by teachers and parents. Parents of children whose scores were positive for ADHD (>15) were interviewed by a psychiatrist and the ADHD was diagnosed based on DSM-IV diagnostic criteria and the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime Version. Results: One hundred thirty-three (12.3%; CI95%: 10.3 –14.2%) children were diagnosed to have ADHD. Conclusion: The prevalence of ADHD in preschool-age children in North-East of Iran is consistent with previous studies in other countries. This study recommends the need for diagnosis and treatment of ADHD in preschool-age children.

Hepatocellular carcinoma: an update.

Abstract: Hepatocellular carcinoma is one of the most common malignant tumors worldwide. The major etiologies and risk factors for HCC development are well-defined and some of the multiple steps involved in hepatocarcinogenesis have been elucidated in recent years. Despite these scientific advances and the implementation of measures for early hepatocellular carcinoma detection in patients at risk, patient survival has not yet significantly improved during the last three decades. This is in part due to the advanced stage of the disease at the time of diagnosis, and in part due to the limited therapeutic options. These fall into five main categories: 1) surgical interventions, including liver transplantation; 2) percutaneous interventions, including ethanol injection and radiofrequency thermal ablation; 3) transarterial interventions; 4) radiation therapy; and 5) drugs as well as gene and immune therapies. While surgery and percutaneous as well as transarterial interventions are effective in patients with limited disease (1-3 lesions, <5 cm in diameter) and compensated underlying liver disease (cirrhosis Child A), at the time of diagnosis, more than 80% of patients present with multicentric hepatocellular carcinoma and advanced liver disease or comorbidities that restrict the therapeutic measures to best supportive care. Therefore, early diagnosis, the development of novel systemic therapies for advanced disease and hepatocellular carcinoma prevention are of paramount importance. New technologies, including gene expression profiling and proteomic analyses, should allow to further elucidate the molecular events underlying hepatocellular carcinoma development and to identify novel diagnostic markers as well as therapeutic and preventive targets.

Type of food and risk of oral cancer.

Abstract: Cancer is the eventual outcome of the interaction between genetic factors and environmental exposures. Nutrition and diet, as environmental factors and determinants of growth and body composition can contribute to the risk of some human cancers such as oral cancer. This article explains the ways of carcinogenesis and the effect of diet on this process, especially focusing on head, neck, and oral cancers. To reduce the risk of oral and pharyngeal cancer, especially squamous cell carcinoma, the most common oral cancer, diet must be optimized, primarily to reduce calorie intake, monounsaturated fat, and red or processed meat. Consumption of fruits, vegetables, and cereals, which are the major source of vitamins and fiber, should be adequate in the daily diet. Optimal levels of daily allowance of micronutrients like vitamin C, E, antioxidants, zinc, βcarotene, and folate are effective in prevention of oral cancer. Consumption of fried or broiled foods and employment of microwave cooking, because of formation of heterocyclic amines, must be avoided because of increasing risks of oral cancer including the salivary gland tumors.

Gardner's Syndrome Presenting With Dental Complaints

Abstract: Dental professionals play an important role in discovering the early signs of many illnesses. Gardner’s syndrome, which affects one in 7500 births in the United States, is an inherited autosomal dominant disorder. There are three distinctive features associated with this syndrome: familial intestinal polyposis or adenomatosis, surface tumors of hard tissues particularly osteoma in the skull, maxillae, and mandible, and finally surface tumors of the soft tissue. The intestinal polyps have a 100% risk of undergoing malignant transformation if not treated. Consequently, early identification of the disease is critical. In this article an 18-year-old male patient with previously undiagnosed Gardner’s syndrome who presented for removal of multiple impacted and unerupted teeth is reported to illustrate the importance of early detection and proper referral. This report describes an unusual presentation of a patient seeking extraction of teeth only, while he was totally unaware of potentially deadly situation.

Khorasan Stroke Registry: Analysis of 1392 Stroke Patients

Abstract: Background: The hospital-based stroke registry is useful for understanding diverse clinical characteristics of stroke related to geographical, racial, or environmental differences. Methods: The Khorasan Stroke Registry was established for evaluation of incidence, clinical manifestations, risk factors, topography, and etiology of ischemic stroke in Southern Khorasan, Iran, during 2001 – 2005. Consecutive stroke patients underwent a standard battery of diagnostic investigations by a stroke neurologist. Topography and etiology of brain infarction was determined based on the Practical Iranian Criteria classification. Results: The incidence of ischemic stroke in Khorasan population is 43.17 cases per 100,000 people per year. During a 5-year period 1,392 ishemic stroke patients (738 females, 654 males) were evaluated in the Khorasan Stroke Registry. Atherosclerosis constituted 53.6% of etiologies followed by uncertain causes (19.9%), cardioembolism (11.8%), and miscellaneous etiologies (2.9%). Eleven point seven percent of our patients had both atherosclerosis and cardioembolic mechanisms. Rheumatic valvular disease was present in 44.8% of cardioembolic strokes and caused 4.31 preventable stroke cases per 100,000 Iranian population per year. Hypertension and history of ischemic cerebrovascular events were the most frequent risk factors, 53.1% and 22.3% respectively. In-hospital mortality of our ischemic stroke patients was 7.3%. Conclusion: High frequency of atherosclerotic etiology in the Khorasan Stroke Registry is because of its classification criteria, which does not separate small vessel territory infarcts as a different etiologic subtype. Rheumatic valvular disease is an important cause of stroke in Khorasan population.

Clinical presentation and etiologic factors of hirsutism in premenopausal Iranian women.

Abstract: Background: Hirsutism is a common clinical condition with different etiologies. Many of these patients have frank or subclinical abnormalities in the adrenal and ovarian steroidogenesis. The disease may be associated with other clinical signs of hyperandrogenism. The objective of this study was to investigate the clinical features of hirsutism and its etiologic factors in premenopausal Iranian women. Methods: In a cross-sectional study, 790 consecutive premenopausal women referred to the dermatology Clinics of Hazrat-e Rasool and Firoozgar University Hospitals and three private dermatology clinics during 2001 – 2003 with the clinical diagnosis of hirsutism were studied. All patients underwent detailed clinical assessment and transabdominal ultrasonography of the ovaries. Endocrinologic work-up was performed for 285 patients. Results: Hirsutism was mild in 65%, moderate in 32.5%, and severe in 2.5% of the patients. Positive family history was found in 56.2%. Hormonal studies revealed some abnormalities in 35.2% of the patients. Coexisting medical conditions included acne in 70% of the patients, menstrual irregularity in 38.6%, androgenic alopecia in 21.3%, obesity in 6.5%, acanthosis nigricans in 4.9%, and diabetes in 0.6% of the patients. Etiology of hirsutism was identified as polycystic ovary syndrome (62.53%), idiopathic (35.19%), congenital adrenal hyperplasia (0.38%), prolactinoma (0.13%), and undetermined (1.77%). Polycystic ovary syndrome was diagnosed more frequently in women with menstrual irregularity than eumenorrheic patients (97.70% vs. 40.41%, P < 0.001). Conclusion: Hirsute patients frequently have either elevated androgen levels or clinical conditions associated with hyperandrogenemia. Eumenorrhea does not rule out endocrine abnormality and particularly polycystic ovary syndrome which is a common cause of hirsutism. We recommend performing endocrinologic work up, investigation of coexisting hyperandrogenic states, and evaluation of polycystic ovary syndrome in all patients with hirsutism.

Association of Rosacea with Demodicosis

Abstract: Background: There are controversial reports about the role of Demodex mites in pathogenesis of acne rosacea. The aim of this study was to examine the relationship between the presence and number of Demodex mites and the pathogenesis of rosacea. Methods: In this case-control study, the prevalence of Demodex mites was studied in facial biopsy of 75 patients with acne rosacea as case group, and in 75 patients with discoid lupus erythematosus and 75 patients with actinic lichen planus as control groups. Results: The prevalence of Demodex mites in patients with acne rosacea (38.6%) was significantly higher than the patients with discoid lupus erythematosus (21.3%) and actinic lichen planus patients (10.6%) (P < 0.001). Conclusion: This study suggests that Demodex mites may play a role in pathogenesis of rosacea but it is not clear whether rosacea merely provides a suitable environment for multiplication of mites, or the mites play a role in the pathological changes.

Determinants of seeking needed outpatient care in Iran: results from a national health services utilization survey.

Abstract: Background/Objective: To assess the inequity in seeking needed outpatient services in Iran and to investigate its influential factors. Methods: The data were taken from a nation-wide Iranian health survey conducted in 2003. This study is based on individuals aged 15 years and over who had mentioned their need to seek outpatient care within two weeks prior to the day of the interview. The outcome was seeking needed outpatient care. The independent variables included respondents' age, gender, marital status, education, occupation, index of household economic status, health insurance status and residential place (urban vs. rural). Results: Sixty-nine point five percent of those in need sought outpatient care. The rich (OR: 2.38, 95% CI: 1.64 - 3.43) and the health insured (OR: 1.62, 95% CI: 1.25 - 2.08), the pensioners and the retired (OR: 2.26, 95% CI: 1.22 - 4.20), the housewives (OR: 1.77, 95% CI: 1.07 - 2.95) were more likely to seek outpatient care than other occupations. On the other hand, people living in remote rural areas (OR: 0.40, 95% CI: 0.28 - 0.57) were less likely to seek their needed outpatient care than those living in main rural areas and urban areas. Conclusion: As in different parts of the world, differences in seeking needed healthcare still exist across different groups in Iran. Indeed, seeking outpatient care in Iran is related not only to health system functions-like health insurance and health facilities-but also on factors beyond the scope of health authorities such as economic status and occupation.

The prevalence of depression among high school and preuniversity adolescents: Rasht, northern Iran.

Abstract: Background: Depression is an important mental health problem, which is quite unknown among adolescents in our community. We conducted this study to determine the prevalence of depression among high school and preuniversity students of Rasht, northern Iran. Methods: We studied 4,020 randomly-selected individuals out of 41,815 high school and preuniversity students. Beck’s self-administered standard questionnaire and a predetermined form containing some demographic variables were applied to measure variables. Results: Two hundred ninety-nine subjects (due to incomplete responses) and 40 subjects (evening-school students) were excluded from our study. One thousand two hundred fifty (34%: CI95% 32.4 – 35.4%) out of 3,681 subjects suffered from depression. There were significant differences between the prevalence of depression and type of school (P < 0.001), educational field (P < 0.0005), socioeconomic class (P = 0.0002), and gender (P < 0.001). There was no significant difference between the prevalence of depression and city district, school grade, and age of participants. Conclusion: Our study indicates that depressive symptoms are common in our subjects and they have significant association with low socioeconomic status. We, therefore, recommend the use of psychiatric interview and analytical methods for determination of the prevalence of depressive disorders and its relationship with studied variables.

Furazolidone-based, metronidazole-based, or a combination regimen for eradication of Helicobacter pylori in peptic ulcer disease.

Abstract: Background: Furazolidone has been effective against Helicobacter pylori in Iran, with no resistance, but with intolerable side effects in the second week. One-week regimens have not been useful here. We compared the efficacy and side effect profiles of three anti-H.pylori regimens. Methods: Patients with peptic ulcer disease and positive H.pylori infection were randomly allocated into three groups. The patients in group A received omeprazole 20 mg + amoxicillin 1g + metronidazole 500 mg, and bismuth subcitrate 240 mg twice daily each, for two weeks; the patients in group B received the same regimen but metronidazole was replaced by furazolidone 200 mg twice daily; and the patients in group C received regimen B for the first week and regimen A for the second week. H.pylori eradication was verified with 13 C- urea breath test at the tenth week. Results: Three hundred and fourteen patients were enrolled; 107, 104, and 103 patients in groups A-C, respectively but 278 patients completed the study. Seven, three, and six patients discontinued their medication in groups A-C, respectively. Fever, dizziness, and weakness were more common in group B than group C (P < 0.05). Vomiting, pruritus, and rash were more common in group C than group A (P < 0.05). Per-protocol eradication rates were 83.1%, 95.2%, and 95.3% in groups A-C, respectively (P = 0.005, groups A and C). Intention to treat eradication rates were 74.5%, 87.0%, and 86.6% in groups A-C, respectively (P = 0.02, groups A and C). Conclusion: One-week furazolidone followed by one-week metronidazole regimen is as efficient as two-week furazolidone regimen but with fewer side effects. Furazolidone-based regimens are superior to metronidazole-based ones for H.pylori eradication in Iran.

Expression of p53 in colorectal carcinoma: correlation with clinicopathologic features.

Abstract: Background: The p53 gene mutation is closely related to carcinogenesis in most malignant diseases. The main function of wild p53 protein is to maintain the integrity of genes by detecting mutations and preventing the division of cells with damaged DNA. The mutated form of p53 protein is overexpressed due to an extended half-life and can be easily detected by immunohistochemistry. Objective: To estimate the frequency of p53 protein overexpression in colorectal carcinoma and its correlation with some clinicopathologic variables. Methods: One hundred paraffin-preserved colorectal carcinoma samples were collected randomly from patients undergoing tumor resection from April 1995 through April 2001 in Omid Hospital, affiliated to Mashhad University of Medical Sciences, Mashhad, Iran. The overexpression of p53 protein was studied using a monoclonal antibody (clone DO-7; Dako). The number of cells stained were classified semiquantitatively as (-): 75% positive cells. Clinicopathologic data including gender, age, tumor location, histologic type, and stage (Astler-Coller) were collected from the files maintained at the Department of Pathology. The correlation between p53 protein overexpression and each variable was evaluated using Chi-square analysis. Results: p53 staining was positive in 59 of 100 specimens. Out of these 100 specimens, 16 were weekly (+), 16 moderately (++), and 27 intensely (+++) positive for p53 protein overexpression. There was no significant correlation between p53 staining and gender (P = 0.34), age (< 40 vs. ≥ 40 yr; P = 0.74), site of tumor (right vs. left colon and rectum; P = 0.26), pathologic type (mucinous vs. nonmucinous; P = 0.63), and stage of the disease (P = 0.12). Conclusion: Considering the p53 protein overexpression in a relatively high percentage of patients, it seems that p53 mutation plays an important role in development of colorectal carcinoma. There was no significant association between p53 protein expression and some common clinicopathologic variables such as age, gender, site of tumor, pathologic type, and stage of the disease.

Consequence of body packing of illicit drugs.

Abstract: Background: During the last decade, increased rates of drug traffic have led the smugglers to use various methods. One of these methods of illicit drug smuggling is body packing. Smuggling by intra-abdominal concealment is called "body packing". In this research, mortality rate was investigated due to body packing in Tehran. Methods: A descriptive study (case series) was designed on all corpses referred to the Forensic Medicine Organization of Tehran between April 1999 - December 2000. Demographic data such as sex, age, marital status, addiction, job, education level, type of opioid and the weight, number of packets, and results of blood and urine morphine tests by thin-layer chromatographic method were investigated. Results: Continental system of law is used in Iran and 0.06% of the referred corpses to Forensic Medicine Organization of Tehran were body packers. There were 12 cases, all of them were men. The mean age of body packers was 43 years (range 20 – 62). The minimum weight of the packets was 20 g and the maximum weight was 1400 g (mean = 501 g). The minimum number of the packets was one and the maximum number of the packets was 48. Twenty five percent of the corps were putrefied and one corpse was mummified. None of the body packers had academic education nor were employed. Nine of them lived in cities. Twenty five percent of them were intravenous addicts. The corpses were found mostly in terminals (17%), roads (58%), and cities (25%). Conclusion: Hospital physicians may neglect this type of gastrointestinal foreign body if they are not aware of the body packer syndrome. Body packing should be suspected in anyone with signs of drug-induced toxic effects after a recent arrival on city terminals or when there is no history of recreational drug use.

Equality in Safe Delivery and Its Determinants in Iran

Abstract: Background/Objective: To determine the equality in safe delivery indices, i.e., appropriate place of delivery, type of delivery and skilled attendant for delivery, and their determinants in Iran. Methods: This study was performed using the data of Iran demographic and health survey, performed in 2000. Our sample was nationally representative and included 17,991 Iranian married women aged 10 – 49 years who had delivered during two years before the survey. The equality status was assessed by concentration index. The relationship between different factors and safe delivery was investigated by logistic regression. These factors included age, occupation, resident place (urban vs. rural), mother’s educational level and household economic status (weighted asset index). Results: Concentration index (95% CI) for appropriate place of delivery, normal vaginal delivery and skilled attendant for delivery, were 0.111 (0.107 to 0.115), -0.100 (-0.105 to -0.095) and 0.095 (0.091 to 0.099), respectively. In other words, the opportunity of delivery in appropriate place and by skilled attendant were more common in those with higher economic levels; while normal vaginal delivery was less common. Also, mother's age and educational level had significant correlation with safe delivery indices; in all cases mother's education was the most important factor. Conclusion: In spite of the improvement in delivery care in Iran during the past decades, there are significant differences between the current situations of safe delivery in people with different socioeconomic states.

A Predictor Model for Suicide Attempt: Evidence from a Population- Based Study

Abstract: Background: There is an extreme need for planning to prevent suicide in developing countries. It is necessary to detect the risk factors of this problem and plan to control them. The aim of this study was to determine a predictive model for suicide attempt based on its risk factors in order to give information for planning therapeutic, preventive, and educational interventions in Karaj City. Methods: The setting was Karaj City, Tehran Province, Iran and the study design was crosssectional. In this study, data were collected by using the World Health Organization (WHO) questionnaire of SUPRE-MISS study. The questionnaire included questions about demographic characteristics, personal and family history of suicide behaviors, use of psychotropic drugs, physical and mental disorders, and community stress. All parts of the questionnaire were filled out by interview. A total of 2300 individuals participated in this study having considered the 1.2% prevalence of suicide attempt in the pilot study, and with type one error rate of 5%, the sample size was calculated as 2300. Results: About 65% of the participants were females. Most of the participants had high-school education (48%) and 57.2% of them were married. Housewives included most of the occupation categories (46%). The mean age of the suicide attempters and nonattempters was 26 (±9) and 32 (±13) years, respectively. This difference was statistically significant. Younger age, female sex, history of mental disorders, lifelong use of tobacco and alcohol, and unemployment were the independent predictors of suicide attempt. Conclusion: Prevention of suicide is possible by understanding its risk factors and planning to control them.

Effect of clofibrate in jaundiced full-term infants:a randomized clinical trial.

Abstract: Background: Hyperbilirubinemia is a common problem in newborn infants. It can progress to kernicterus in severe forms, unless an intervention is initiated. The objective of this study was to determine the therapeutic effect of clofibrate in full-term neonates with nonhemolytic jaundice. Methods: A randomized clinical trial was performed on two groups of full-term jaundiced neonates: the clofibrate-treated group (n = 30) and the control group (n = 30). Infants in the clofibrate group received a single oral dose of 100 mg/kg clofibrate while the neonates in the control group received distilled water (same color and volume); both groups received phototherapy. Serum total and direct bilirubin levels were measured at the beginning, 16, 24, 48, and 74 hours, after the start of the trial. Results: The mean ± SD total serum bilirubin level of the control and clofibrate groups at enrollment was 17.5 ± 2.3 and 18.2 ± 1.9 mg/dL, respectively (P = 0.199). The mean ± SD total serum bilirubin in the control and clofibrate groups after 48 hours was 11.4 ± 2.4 and 10.1 ± 2.4 mg/dL, respectively (P = 0.047). After 72 hours of intervention, 25 (83%) neonates of the clofibrate group and 16 (53%) of the control group were discharged with a total serum bilirubin of <10 mg/dL (P = 0.026). No side-effect was observed on serial examination during hospitalization, and on the first and seventh day after discharge. Conclusion: Clofibrate results in a faster decline in TSB, shorter duration of hospitalization and had no side effects in jaundiced full-term neonates. Archives of Iranian Medicine, Volume 10, Number 3, 2007: 349 – 353.

Benign metastasizing leiomyoma of the uterus

Abstract: Herein, we report on a well-characterized benign metastasizing leiomyoma, presented in an unusual site. Up to the knowledge of authors, so far, only 76 cases of benign metastasizing leiomyoma have been reported. The tumor presented as a retroperitoneal mass three years after a hysterectomy Performed for leiomyomatosis of the uterus with extensive areas of hyalinization. Histopathologic and immunohistochemical studies of the resected mass were similar to the uterine leiomyoma, showing moderate cellularity of bland looking smooth muscle cells with minimal atypia, inconspicuous mitosis, and no necrosis in a hyalinized background.

The historical backgrounds of the ministry of health foundation in Iran.

Abstract: The early efforts for promotion of public health measures and prevention of fatal epidemic diseases in Iran date back to the second half of the 19 th century. Based on historical records, the informal protosanitary councils had existed since the early 1850s, but a new formal health institution called “Sanitary Council”, or “Majles-e Hefz al-Sehheh” was founded in 1881. Then, it was reestablished as a permanent council in 1904. The Sanitary Council was the only major public health authority under the auspices of “Ministry of the Interior” up to 1920. Then the Ministry of Health and Charity Affairs or “Vezarat-e Sehhyeh va Omuor-e Kheiryyeh” was founded in 1920, but it was dissolved in 1921. Between 1921 and 1941, there was no ministry of public health in Iran and during this period, the public health and medical affairs were mananged by the Public Health Administration known as Sehhyeh Koll-e Mamlekati that was established in 1926 and finally in 1941, the Ministry of Health ( Vezarat-e Behdari) was founded. Presented here, is the historical backgrounds of the foundation of the Ministry of Health in Iran, as well as the list of the Health Ministers between 1941 and 1979.