Showing papers in "Archives of Iranian Medicine in 2008"

Epidemiology and Heterogeneity of Hypertension in Iran: A Systematic Review

Abstract: There are many descriptive studies on hypertension in Iran, mostly assessing the prevalence of the disease and its associations with various risk factors. In order to gain a better insight into the epidemiology of hypertension in Iran and its heterogeneity around the country, we systematically reviewed all available studies and analyzed their findings using meta-analysis methods. All published papers in Iranian and international journals, final reports of research projects, papers presented in relevant congresses, and also all dissertations of medical students were reviewed using standard keywords. Studies published during 1996 – 2004, which met the eligibility criteria were entered into meta-analysis. We found 38 studies, of which 29 were eligible with a total sample size of 93,661 subjects. Also, we accessed the results of a very large national survey, which reported the prevalence of hypertension in 27 provinces. Our estimation for the overall prevalence of hypertension in 30 – 55 and >55-year-old population were around 23% and 50%, respectively. The prevalence in men was 1.3% less than that in women (P<0.0001). The mean diastolic blood pressure in men was 0.62 mmHg less than that in women while the mean systolic blood pressure was 0.67 mmHg greater. We found a sharp increase in the prevalence of hypertension by age, and also greater risk in females. It seems that the overall prevalence of hypertension in Iran is considerable. Iranian health system should pay more attention to control and treatment of hypertension in general population.

Cancer Registry in Iran: a Brief Overview

Abstract: Cancer registry is an important tool for any successful cancer control program. The first formal cancer related data from Iran were published in 1956. In 1969, observations documenting a high incidence of esophageal cancer in the Caspian Littoral, urged researchers to set up the first population-based cancer registry in this region. This cancer registry was established jointly by University of Tehran and the International Agency for Research on Cancer (IARC). In 1976, another cancer registry started its activities in Fars Province. In 1984, the Parliament passed a bill mandating the report of all tissues “diagnosed or suspected as cancer tissue” to the Ministry of Health. While only 18% of all estimated cancer cases were reported in first reports, this rate increased to 81% in 2005 In 1998, Tehran Population-Based Cancer Registry started to collect data from cases of cancer referred to the treatment and diagnostic facilities throughout the Tehran metropolis. Digestive Disease Research Center, Tehran University of Medical Sciences, established four new population-based cancer registries in Northern Iran and another in Kerman Province in the south. These five provinces have a total population of about 9.5 million, and constitute about 16% of the total population of Iran. While the pathology-based cancer registration is in place, we hope that the addition of the population-based cancer registries, and establishment of new registries in poorly-covered areas, will improve cancer reporting in the country.

The impact of low serum triglyceride on LDL-cholesterol estimation.

Abstract: Most clinical laboratories directly measure serum triglyceride, total cholesterol, and high- density lipoprotein cholesterol. They indirectly calculate low-density lipoprotein cholesterol value using the Friedewald equation. Although high serum triglyceride (>400 mg/dL or 4.52 mmol/L) devaluates low-density lipoprotein cholesterol calculation by using this formula, effects of low serum triglyceride (<100 mg/dL or 1.13 mmol/L) on its accuracy is less defined.Two hundred thirty serum samples were assayed during a one-year period. In 115 samples, the triglyceride level was below 100 mg/dL and in 115 samples from age- and sex-matched patients the triglyceride level was 150 - 350 mg/dL (1.69 - 3.95 mmol/L). In both groups total cholesterol was above 250 mg/dL (6.46 mmol/L). On each sample, total cholesterol, high-density lipoprotein cholesterol, and triglyceride were directly measured in duplicate and low-density lipoprotein cholesterol measured directly and calculated with Friedewald equation as well. Statistical analysis showed that when triglyceride is <100 mg/dL, calculated low- density lipoprotein cholesterol is significantly overestimated (average :12.17 mg/dL or 0.31 mmol/L), where as when triglyceride is between 150 and 300 mg/dL no significant difference between calculated and measured low-density lipoprotein cholesterol is observed. In patients with low serum triglyceride and undesirably high total cholesterol levels, Friedewald equation may overestimate low-density lipoprotein cholesterol concentration and it should be either directly assayed or be calculated by a modified Friedewald equation. Using linear regression modeling, we propose a modified equation.

Neurotoxic disorders of organophosphorus compounds and their managements.

Abstract: Organophosphorus compounds have been used as pesticides and as chemical warfare nerve agents. The mechanism of toxicity of organophosphorus compounds is the inhibition of acetylcholinesterase, which results in accumulation of acetylcholine and the continued stimulation of acetylcholine receptors. Therefore, they are also called anticholinesterase agents. Organophosphrus pesticides have largely been used worldwide, and poisoning by these agents, particularly in developing countries, is a serious health problem. Organophosphorus nerve agents were used by Iraqi army against Iranian combatants and even civilian population in 1983 – 1988. They were also used for chemical terrorism in Japan in 1994 – 1995. Their use is still a constant threat to the population. Therefore, medical and health professionals should be aware and learn more about the toxicology and proper management of organophosphorus poisoning. Determination of acetylcholinesterase and butyrylcholinesterase activity in blood remains a mainstay for the fast initial screening of organophosphorus compounds but lacks sensitivity and specificity. Quantitative analysis of organophosphorus compounds and their degradation products in plasma and urine by mass spectrometric methods may prove exposure but is expensive and is limited to specialized laboratories. However, history of exposure to organophosphorous compounds and clinical manifestations of a cholinergic syndrome are sufficient for management of the affected patients. The standard management of poisoning with organophosphorous compounds consists of decontamination, and injection of atropine sulfate with an oxime. Recent advances on treatment of organophosphorus pesticides poisoning revealed that blood alkalinization with sodium bicarbonate and also magnesium sulfate as adjunctive therapies are promising. Patients who receive prompt proper treatment usually recover from acute toxicity but may suffer from neurologic complications.

Clinical and laboratory findings in neurobrucellosis: review of 31 cases.

Abstract: Background: Neurobrucellosis is an uncommon complication of brucellosis. The clinical features of neurobrucellosis vary greatly and, in general, tend to be chronic. Many of the laboratory procedures usually employed in the diagnosis of brucellosis frequently give negative results. For these reasons, and because brucellosis is a disease, which is both treatable and curable, the degree of suspicion must be high, especially in endemic areas, so that an early diagnosis can be made to allow suitable treatment to be established. Methods: A retrospective analysis of 31 cases of neurobrucellosis was carried out. Results: Meningitis and meningoencephalitis were the most common form of neurobrucellosis in our patients. The most commonly-used antibiotics were combinations of rifampin, doxycycline, and trimethoprim-sulfamethoxazole. Conclusion: The differential diagnosis of neurobrucellosis is wide. However, the disease should be ruled out in all patients who develop unexplained neurological symptoms, especially in those who live in endemic areas.

Pharyngocutaneous fistula after laryngectomy: incidence, predisposing factors, and outcome.

Abstract: Pharyngocutaneous fistula is a common and troublesome postoperative complication after total laryngectomy. The objective of this report was to determine the incidence, predisposing factors, and outcome of postlaryngectomy pharyngocutaneous fistula in patients operated on in our department and to describe the management of the complication. The medical records of 146 consecutive patients who underwent laryngeal surgery for squamous cell carcinoma of the larynx between 1990 and 2005 were assessed. All patients had similar preoperative/postoperative care. We studied a number of factors that could influence fistula formation such as age, gender, smoking, systemic disease, preoperative radiotherapy, previous tracheotomy, site of tumor, surgical procedure, positive surgical margins, type of closure (T vs. vertical), concurrent neck dissection, suture material, clinical stage, histologic grade, and experience of surgeon (consultant vs. resident). A pharyngocutaneous fistula was observed in 13% (19/146) of the patients within a mean time of 9.6 days from surgery. Spontaneous closure with local wound care was noted in 17 (89%) patients whereas a surgical closure was necessary in two. One patient required surgical closure by direct suture of the pharyngeal mucosa. Pectoralis major myocutaneous flap was used in another one. Our findings showed that fistula formation was significantly more common in patients who received previous radiotherapy or who had positive surgical resection margins or had a systemic disease. The mean healing time was 26 days. We concluded that pharyngocutaneous fistula remains a troublesome complication of the early postoperative period after total laryngectomy. There are many conflicting reports in the literature concerning the predisposing factors, but our data showed that the presence of systemic diseases, previous radiotherapy, and positive surgical margins can all be important predisposing factors, or at least underlying causes. Our experience confirmed that most fistulas can be successfully managed with conservative treatment.

Health-related quality of life in patients with hiv/aids

Abstract: Background: The present study was conducted to determine the health-related quality of life in patients living with human immunodeficiency virus or suffering from acquired immune deficiency syndrome (HIV/AIDS), referred to Behavioral Diseases Consultation Center in west of Tehran, Iran. Methods: This cross-sectional study was conducted using a convenience sampling method on 139 patients living with HIV or suffering from AIDS at the first half of the year 2006. The method of data collection was summarized questionnaire of World Health Organization (WHO-QOL-Brief). The main measured outcome in this study was quality of life and some related demographic and clinical variables. Results: The majority of the patients were males (88.5%) with secondary education (45.3%) and married (27.3%); the majority of them were unemployed (65.4%). The mean±SD age of the patients was 35.4±6.4 years. Gender, marital status, level of education, CD4+ count, and clinical stage of the disease, had a significant effect on the quality of life of the patients. In multivariate analysis, the most important predictor of the quality of life was clinical stage of the disease. Conclusion: The most important factors, association with decreased quality of life of the patients in this study, were being female, separated or divorced, having less CD4+ count, and being at severe stage of the disease.

Association of body mass index and abdominal obesity with marital status in adults

Abstract: Background: Obesity continues to be an important public health problem worldwide. The objective of this study was to determine the association of body mass index and abdominal obesity with current marital status among the adult population of Iran. Methods: A nation-wide cross-sectional survey was conducted from December 2004 through February 2005.The subjects were selected by stratified probability cluster sampling through household family members in Iran. Weight, height, waist circumference, and marital status of 89,404 men and women aged 15 – 65 (mean: 39.2) years were recorded. Four classes of body mass index, i.e., <18.5, 18.5 – 24.9, 25 – 29.9, and ≥30 kg/cm 2 , and three marital status, i.e., currently-, formerly-, and never-married were used. Abdominal obesity was defined as waist circumference ≥102 cm in men and ≥88 cm in women. Results: The prevalence of overweight was twofold higher in married men (OR: 2.24; 95% CI: 2.08 – 2.41) and women (OR: 2.36; 95% CI: 2.20 – 2.53) than never-married men and women, even when age, educational level, leisure time physical activity, smoking habits, and place of residence were controlled. The multivariate OR of obesity was increased about threefold in married men (2.82; 95% CI: 2.51 – 3.18) and women (3.64; 95% CI: 3.31 – 3.99). The prevalence of abdominal obesity was twofold higher among married men (2.02; 95% CI: 1.79 – 2.29) and about threefold higher among married women (2.87; 95% CI: 2.69 – 3.06). Conclusion: The marital status appears to influence the likelihood of developing overweight, obesity, and abdominal obesity in both men and women in Iran.

The prevalence and adverse effects of group B streptococcal colonization during pregnancy.

Abstract: This study was done to evaluate the prevalence of rectovaginal colonization with group B streptococci among pregnant women who delivered in our center. Also maternal and neonatal complications were compared between colonized and noncolonized groups. Rectovaginal cultures were obtained from 1197 pregnant women with gestational ages greater than 24 weeks who were admitted to the labor room of Zeinabieh Hospital affiliated to Shiraz University of Medical Sciences from April to September 2003. All of the neonates had surface cultures after birth. The B streptococci carrier and noncarrier groups were compared for maternal and neonatal complications that occurred in the first week after delivery.Out of the 1197 pregnant women who were evaluated for B streptococci, 110 (9.1%) had rectovaginal colonization (group 1) and 1087 women were not colonized (group 2). Sixty-six neonates had positive B streptococci cultures after birth with a transmission rate of 60%. One neonate developed early-onset B streptococci sepsis. Out of the 110 women who had positive B streptococci culture, 40 (36.3%) developed preterm labor as compared with 155 (14.3%) out of the 1087 women in group 2 (P=0.001). The mean gestational age of newborns in group 1 was 32.8+/-11 weeks compared with 36.2+/-7.9 weeks for group 2 (P=0.001). Eighteen women (16.3%) in group 1 developed preterm rupture of membranes compared with 65 (6.0%) women in group 2 (P=0.001). Prolonged rupture of membranes was observed in 6.3% of women with B streptococci carrier states as compared with 0.5% in the second group (P=0.001). Intrapartum antibiotics were initiated primarily on the risk based strategy for 34 (30.9%) women in group 1 as compared with 12 (1.1%) in group 2 (P=0.001). There was one neonate with early-onset B streptococci sepsis born from a B streptococci carrier mother without any risk factor. Maternal complications were not different between the two groups. In this study 9.1% of the women had positive rectovaginal B streptococci cultures with a 60% transmission rate to their neonates. Also preterm birth, prolonged rupture of membranes, and preterm premature rupture of membranes had a higher incidence among B streptococci colonized mothers.

Presence of lead in opium.

Abstract: Opium addiction is a common form of addiction in Middle East countries such as Iran Recently several reports suggested some kinds of pathologic findings such as abdominal pain, nephropathy, and anemia in opium addict patients Such pathologic findings suggest lead poisoning in the patients In this study, the concentration of lead in 10 opium samples was evaluated The mean concentration of lead in the opium samples was 188 ppm This may explain some of the pathologic findings found in addict patients The authors would suggest further investigations to evaluate the lead concentration in opium addicts' sera and also routine screening for lead poisoning in opium addict patients

The Prevalence of Psoriatic Arthritis in Psoriatic Patients in Tehran, Iran

Abstract: Background: Psoriatic arthritis is an inflammatory arthritis which is associated with psoriasis. There is no general agreement in the literature regarding the epidemiology of psoriatic arthritis. In this study, we evaluated the prevalence of psoriatic arthritis in a relatively large number of psoriatic patients. Methods: Three hundred and twenty patients with psoriasis were evaluated in a crosssectional study. The psoriasis area and severity index, family history, demographic variables, and some other factors (e.g., clinical type and location of the disease) were assessed. The patients were examined for signs of arthropathy and the suspects were referred to a rheumatologist for further evaluation and confirmation of the diagnosis. Results: Psoriatic arthritis was observed in 29 (9.1%) patients. The prevalence of Psoriatic arthritis in men (10.1%) was not statistically different from that of women (7.8%). The most common type of psoriasis in all patients, with and without psoriatic arthritis, was chronic plaque psoriasis. The mean±SD psoriasis area and severity index was significantly (P<0.05) higher in patients with psoriatic arthritis (24.33±10.36) than those without psoriatic arthritis (10.70±8.44). Nail involvement was significantly more common in patients with psoriatic arthritis than those without psoriatic arthritis. HLA B27 was the most common HLA detected in patients with psoriatic arthritis.

Distribution of symptoms of attention deficit-hyperactivity disorder in schoolchildren of Shiraz, south of Iran.

Abstract: Background: This study was conducted to study the prevalence rate of attention deficit hyperactivity disorder symptoms and differences between subtypes in school age children of Shiraz, south of Iran. Methods: A random sample of 2000 school age children from both genders was selected. A parent-completed, DSM-IV-referenced rating scale of attention deficit hyperactivity symptoms was used. Results: About 10.1% of participants obtained screening cutoff scores for attention deficit hyperactivity; 13.6% in boys and 6.5% in girls. The most common type of probable attention deficit hyperactivity in boys and girls was the hyperactive-impulsive type of attention deficit hyperactivity and the least frequent type was the combined type of attention deficit hyperactivity. Conclusion: The rate of probable attention deficit hyperactivity in Shiraz, southern Iran is very similar to other counties and it is more common in boys than girls.

Determinants of seeking needed outpatient care in Iran: Results from a national health services utilization survey (vol 10, pg 439, 2007)

Abstract: BACKGROUND To assess the inequity in seeking needed outpatient services in Iran and to investigate its influential factors. METHOD 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. CONCLUSIONS 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. This study can be instrumental for the recent five-year Economic, Social and Cultural Development Plan of Iran which identified the reduction of inequalities in social determinants of health [corrected]

The prevalence at birth of overt congenital anomalies in urmia, northwestern iran

Abstract: Background: Congenital anomalies play a significant role in perinatal and infantile morbidity and mortality. There is a variation in the frequency of congenital anomalies in different populations. Determination of the prevalence of different types of congenital anomalies may help plan primary prevention measures for these anomalies. The objective of this study was to determine the prevalence at birth of overt congenital anomalies in Urmia, in the northwest of Iran. Methods: In a cross-sectional hospital-based study, charts of 14,121 deliveries including livebirths and stillbirths during the period from January 2001 through June 2005 were studied. Results: A total of 264 (187 per 10,000 births) anomalies were detected. The anomaly categories with the highest prevalence were nervous system defects (52.65%) followed by musculoskeletal defects (23.86%). The total prevalence at birth of overt congenital anomalies was 1.87%. The rates for live- and stillbirths were 1.17% and 40.7%, respectively. Conclusion: Considering the high frequency of central nervous system anomalies recorded in our study, it seems to be reasonable to pay more attention to the role of periconception vitamin supplementation for the primary prevention of congenital anomalies, particularly neural tube defects.

Frequency of BCR-ABL fusion transcripts in Iranian patients with chronic myeloid leukemia.

Abstract: Background: A specific chromosomal abnormality, the Philadelphia chromosome, is present in 90 – 95% of patients with chronic myeloid leukemia. The aberration results from a reciprocal translocation of chromosomes 9 and 22, creating a BCR-ABL fusion gene. There are two major forms of the BCR-ABL fusion gene, involving ABL exon 2, but including different exons of BCR gene. The transcript b2a2 or b3a2 codes for a p210 protein. Other fusion gene leads to the expression of an e1a2 transcript, which codes for a p190 protein. Other less common fusion genes are b3a3 or b2a3 (p203) and e19a2 (p230). The incidence of one or other rearrangement in chronic myeloid leukemia patients varies in different reports. In general, fusion transcripts are determined individually, a process which is labor- intensive in order to detect all major fusion transcripts. The objective of this study was to set up a multiplex RT-PCR assay for detection and to determine the frequency of different fusion genes in 75 Iranian patients with chronic myeloid leukemia. Methods: Peripheral blood samples were analyzed by multiplex RT-PCR from 75 adult Iranian chronic myeloid leukemia patients to detect different types of BCR-ABL transcripts of the t(9;22). Results: All patients examined were positive for some type of BCR/ABL rearrangement. The majority of the patients (83%) expressed one of the p210 BCR-ABL transcripts (b3a2, 62% and b2a2, 20%), while the remaining showed one of the transcripts of b3a3, b2a3, e1a2 or co-expression of b3a2 and b2a2. The rate of co-expression of the b3a2 and b2a2 was 5%. Conclusion: In contrast to other reports, we did not see any co-expression of p210/p190. Coexpression may be due to alternative splicing or to phenotypic variation, with clinical course different from classic chronic myeloid leukemia.

The prevalence of oral aphthosis in a normal population in Iran: a WHO-ILAR COPCORD study.

Abstract: This study was conducted to determine the prevalence of oral aphthosis in a normal population in Iran, using the data of the WHO-ILAR COPCORD study in Iran. We conducted this study in Tehran, the capital of Iran which was selected as the COPCORD study field. In 22 districts of Tehran, 50 clusters were randomly selected. Of the selected houses, 4,096 households were visited and 10,291 persons were interviewed (response rate of 75%). Out of the 10291 subjects interviewed, 2592 had aphthous ulcers which translated to a prevalence of 25.2% (95% confidence interval: 24.4% to 26.0%). The prevalence of oral aphthosis was rather high in this normal population.

The effectiveness of combined treatment with methylprednisolone and cyclophosphamide in oral paraquat poisoning.

Abstract: Background: Paraquat is a bipyridil herbicide and in appropriate and careful usage, will not be health threatening. Most adult cases of intoxication are due to suicidal attempts rather than accidental exposure. Therapeutic response has been reported to be appropriate with high doses of cyclophosphamide and glucocorticoids and survival is reported to be approximately 75 %. So, this study was designed to evaluate the effects of combined treatment with cyclophosphamide and glucocorticoids in patients with paraquat poisoning. Methods: During a two-year period 45 patients with paraquat poisoning were admitted to Sina Hospital, Hamadan, Iran, of whom 20 had moderate to severe intoxication. Eleven patients (group 1) received conventional treatment and nine patients (group 2) received conventional treatment plus intravenous infusions of cyclophosphamide 15 mg/kg daily for two days, methylprednisolone one gram daily for three days, and mesna 15 mg/kg for four days. Results: The mean age±SD in group 1 was 25±10 years and in group 2 was 26±10 years. In group 1 three patients were females and eight patients were males. In group 2 one patient was female and eight patients were males. There were no differences between the groups in the time elapsed from ingestion to presentation at hospital or in the beginning of hemodialysis. The mortality rate in group 1 was 81.8% and in group 2 was 33.3% (P< 0.05). All fatalities caused by acute respiratory distress syndrome. Conclusion: Pulse therapy with cyclophosphamide and methylprednisolone may be effective in preventing respiratory failure and reducing mortality in patients with moderate to severe paraquat poisoning.

A tribute to Zakariya Razi (865 - 925 AD), an Iranian pioneer scholar.

Abstract: The resurgence of Islamic Civilization in the Near East in the 7 th century AD and its expansion to Persian Empire and Westward provided opportunities of access Persian, Hellenic, and Roman writings in philosophy and medicine Based on their observations and experiences, Islamic physician-philosophers expanded upon those writings and at times challenged them Among these physician-philosophers admiring and challenging Galen was Zakariya Razi described as the greatest physician of Islam and Medieval Ages A search of electronic and written materials

Breast tuberculosis: report of eight cases.

Abstract: Tuberculosis of the breast is an extremely rare disease, which is still present and is also misdiagnosed with carcinoma or bacterial abscesses In this study, we reported on eight patients with mammary tuberculosis during a four-year period The main signs and symptoms of the patients included a painful tender lump in the breast (n=4), a painless lump in the breast (n=3), a lump with sinus (n=1), a sinus without lump (n=1), and an ipsilateral axillary lymphadenopathy (n=1) The diagnosis was confirmed by fine-needle aspiration cytology or histology Antitubercular therapy was the therapeutic mainstay Surgical intervention was reserved for aspiration of cold abscesses, and excision of residual sinuses and masses

The upper normal limit of serum alanine aminotransferase in Golestan Province, Northeast Iran

Abstract: Background: The objective of this study was to determine the upper normal limit of serum alanine aminotransferase level in a population-based study in Golestan Province, northeast Iran. Methods: From the randomly invited individuals (2,292), 698 out of the 916 males and 1,351 out of the 1,376 females participated in the study (participation rate: 76.2% and 98.1%, respectively). One hundred and twenty-one participants were excluded due to positive hepatitis B surface antigen or hepatitis C virus antibody and/or drinking more than 20 grams of alcohol per day. A total of 1,928 participants (1300 females) were included. The upper normal limit of serum alanine aminotransferase level was defined as the 95 th percentile. Results: The upper normal limit of serum alanine aminotransferase level in normal weight and nondiabetics was significantly lower than the total study group (36 versus 45 U/L). Serum alanine aminotransferase level was independently associated with male gender, body mass index, and diabetes mellitus (OR=2.05; 95%CI: 1.44 – 2.94, OR=2.76; 95%CI: 1.84 – 4.13, and OR=2.96; 95%CI: 1.56 – 5.61, respectively). Conclusion: Considering the lower calculated upper normal limit in normal weight nondiabetic participants in this study, we recommend setting new upper normal limit for serum alanine aminotransferase level. It seems reasonable to set upper normal limit for serum alanine aminotransferase level in males and females separately.

Animal bites in Tehran, Iran

Abstract: Animal bites are major public health issues, not only for the risk of acquiring secondary infections but also for the possibility of contracting rabies. The objective of this study was to determine the epidemiology of animal bites in Tehran, Iran. During a three- year period, through a questionnaire- based study, 8806 bitten persons were enrolled into our study. Of these, 79.16% were males and 20.84% were females. Bites were most frequent among the age group of 20-29 years. Most cases were self employed. Upper extremities were the most frequent bite site (53.8%). The offending animals, in order of frequency were dogs, cats, squirrels, monkeys, hamsters, and other animals, responsible in 5804 (65.9%), 2241 (25.44%), 343 (3.89%), 134 (1.52%), 125 (1.41%), and 159 (1.84%) cases, respectively. We found that animal bites are still prevalent in Iran and thus preventive measures and health education are required for the public.

The prevalence of coronary risk factors in Iranian lor migrating tribe.

Abstract: Cardiovascular diseases are the major causes of death in Iran. The aim of this study was to determine the prevalence of conventional risk factors for coronary artery disease in Lor migrating tribes in southern part of Iran. Two hundred six persons of Lor migrating tribes in Mamasani, southern Iran (age range, 21 – 80 years) were randomly enrolled in the study. Their serum total cholesterol, triglyceride, high- density lipoprotein, low- density lipoprotein, and fasting blood sugar were determined. Of the participants, 79.9% were smokers. The prevalence of hypertension was 37.4% (mostly grade 1), 3.6% had diabetes mellitus, and 14.7% had impaired fasting glucose. A cholesterol level of more than 240 mg/dL was found in 7.1% of the participants, 27.8% had a lowdensity lipoprotein level of more than 130 mg/dL, 38.9% had a high- density lipoprotein level of less than 40 mg/dL, and 25.2% had a triglyceride level of more than 200 mg/dL. Body mass index greater than 25 was found in 34.8% of the participants, and 57.1% had intermediate and high risk for coronary events. The prevalence of conventional risk factors for coronary artery disease in Lor migrating tribes in comparison with Tehran urban population was very high.

Needle-Knife Fistulotomy versus Standard Method for Cannulation of Common Bile Duct: A Randomized Controlled Trial

Abstract: Background: Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy has become widely available for the treatment of pancreatobiliary diseases; however, it has mortality and complications. The aim of this study was to compare the success rates and complications of two different methods of common bile duct cannulation. Methods: From June 2003 though February 2004, patients who were candidates for endoscopic retrograde cholangiopancreatography and/or endoscopic sphincterotomy were randomly divided into two groups: standard cannulation (group A) and suprapapillary needle-knife fistulotomy (group B). Postendoscopic retrograde cholangiopancreatography pancreatitis, cholangitis, bleeding, and perforation were evaluated. Results: Two hundred and eighteen cases (86 males and 132 females with a mean±SD age of 56.2±17.5 years) were enrolled in this study. Group A, contained 112 patients and group B included 106 patients. In group A, the final cannulation success was achieved in 100 patients (89.3%). Cannulation was successful in 88 patients (83.0%) in group B. Difficulty in cannulation occurred more frequently in group A (25.5% vs. 2.6%, P=0.002). There were two patients in group B and three patients in group A who developed pancreatitis after endoscopic retrograde cholangiopancreatography. Perforation occurred in one patient in group B, which was improved with medical support. Bleeding and cholangitis were not occurred in any of the groups. The overall complication rate was 3/112 in group A and 3/106 in group B. Conclusion: Needle-knife fistulotomy is safe and can be applied as an effective alternative to standard technique for common bile duct cannulation in expert hands.

Association of angiotensin-converting enzyme gene insertion/deletion polymorphism with metabolic syndrome in Iranians with type 2 diabetes mellitus.

Abstract: Background: Angiotensin-converting enzyme insertion/deletion polymorphism has been shown to be associated with diabetes, hypertension, coronary artery diseases, and diabetic nephropathy. The objective of this study was to investigate whether angiotensin-converting enzyme gene insertion/deletion polymorphism is associated with metabolic syndrome in Iranians with type 2 diabetes mellitus. Methods: A total of 170 patients with type 2 diabetes mellitus and 91 control subjects were studied. The angiotensin-converting enzyme insertion/deletion polymorphism was determined by polymerase chain reaction (PCR) utilizing specific primers. The definition and criteria of metabolic syndrome used in this study matched that proposed in 1998 World Health Organization classification. Results: Of 170 patients studied, 119 (70%) fulfilled the criteria for metabolic syndrome. The prevalence of angiotensin-converting enzyme genotype in the control subjects with DD, ID, and II genotype was 13.2%, 47.3%, and 39.5%, respectively. In patients with metabolic syndrome, the prevalence was 26.9%, 56.3%, and 16.8%, respectively; in patients without metabolic syndrome, it was 21.6%, 62.7%, and 15.7%, respectively. The angiotensin-converting enzyme insertion/deletion polymorphism was not significantly associated with presence of metabolic syndrome in patients with type 2 diabetes (P=0.711). The frequency of DD genotype in the metabolic syndrome group (26.9%) was higher than that (21.6%) in those without metabolic syndrome (P=0.447) and the control group (13.2%, P=0.02). The frequency of D allele in metabolic syndrome patients was 55.1% as compared to those patients without metabolic syndrome (52.9%, P=0.72) and the control subjects (36.8%, P<0.001). Conclusion: It seems that the DD genotype and/or D allele of angiotensin-converting enzyme gene may increase the risk for developing type 2 diabetes mellitus, but not metabolic syndrome.

Rising incidence of adenocarcinoma of the esophagus in Kerman, Iran.

Abstract: Background: The fall in the incidence of esophageal squamous cell cancer and noncardia gastric cancers in western countries parallels a concomitant rise in the incidence of gastric cardia cancer and distal adenocarcinoma of the esophagus. We aimed to investigate the incidence trend of different gastric and esophageal cancers in Kerman, southeast Iran. Methods: The information of all newly diagnosed patients with gastric and esophageal cancers were collected actively from all histopathology departments around the Kerman Province during 1991 – 2002 retrospectively. Results: The annual age standardized incidence risks of esophageal and gastric cancers in Kerman were 1.9 and 6.9 per 100,000 populations. In average, the risks of gastric and esophageal squamous cell cancers were more or less constant, while the risk of adenocarcinoma of the esophagus increased around 11% annually. Conclusion: The risks of upper gastrointestinal cancers in Kerman Province were quite lower than the average risks in the whole country. The rising incidence of adenocarcinoma of the esophagus in Kerman parallels its temporal pattern in western countries.

Disability and depression in patients with chronic pain: pain or pain-related beliefs?

Abstract: Background: Physical disability and depression in patients with chronic pain have been shown to be associated with pain intensity and pain self-efficacy beliefs. However, little is known about whether pain self-efficacy beliefs can predict depression and physical disability when this relationship is controlled for pain intensity and other related demographic variables The aim of the current study was to replicate and extend previous research on the relationship between painrelated beliefs, depression, and disability by examining these relationships in a heterogeneous sample of Iranian patients with chronic pain. Methods: A group of 430 patients with chronic pain participated in the study and completed questionnaires on demographic variables, pain intensity, pain self-efficacy beliefs, physical disability, and depression. Results: Correlation analyses revealed that patients with higher education were less depressed and less physically disabled. Younger patients were more physically disabled. Pain intensity and pain self-efficacy beliefs were significantly related to physical disability and depression. In hierarchical multiple regression analyses, after controlling for patients’ background variables and pain intensity, pain self-efficacy beliefs accounted for significant variance in depression and physical disability over and above the effect of demographic variables and pain intensity. Patients with higher pain self-efficacy, compared to those with lower self-efficacy, were less depressed and less physically disabled. Conclusion: Pain self-efficacy was more strongly related to depression and physical disability than pain intensity and demographic variables. The findings of the present study suggest the importance of targeting pain self-efficacy beliefs for modification in treatment of patients with chronic pain.

Nail molybdenum and zinc contents in populations with low and moderate incidence of esophageal cancer.

Abstract: Background: The objective of our study was to compare the zinc and molybdenum contents of nails in two populations at high and low risk for esophageal cancer in northern Iran Methods: Four groups were studied including a control group in Tehran—a low-risk area (n=20); a group of patients with esophageal cancer from Sari—a moderate- risk region in northern Iran (n=20); a group of patients’ family members (n=20); and a control group in Sari (n=40) Molybdenum and zinc levels were measured in their nail samples using flame atomic absorption spectrometry Results: Both molybdenum and Zinc were significantly (P<001) lower in the Sari control group (molybdenum: 0472 ppm, zinc: 1730 ppm) compared with the Tehran control group (molybdenum: 0740 ppm, zinc: 2515 ppm) These elements were lower in content in patients with esophageal cancer (molybdenum: 0283 ppm, zinc: 1265 ppm) compared with the Sari control group (P<005 for molybdenum and P<0001 for zinc) Only zinc was significantly (P<0001) lower in patients compared with their family members (molybdenum: 0456 ppm, zinc: 1755 ppm) No differences were found between the Sari control group and the patients’ family members in any of the two elements Conclusion: Zinc and molybdenum levels are much lower in north of Iran—a moderate- risk area for esophageal cancer—compared with Tehran—a low-risk area Based on these results, more investigations on the relations of trace elements with esophageal cancer in high-risk areas in northern Iran are warranted

A brief history of the discovery of the circulation of blood in the human body.

Abstract: The present article describes briefly the development of the theories regarding the circulation of blood in humans, from the time of Galen (second century C.E.) to the work of William Harvey (17th century C.E.).We shall summarize the views of Galen together with those of two prominent Iranian physicians of the Middle Ages (Razi and Ahwazi known in the West as Rhazes and Haly Abbas respectively) as well as that of Ibn-Nafis from Damascus (the discoverer of the pulmonary circulation) and the Spanish physician and cleric Michael Servetus and finally the definitive work of William Harvey, the English physician who described the mechanism of both the systemic and pulmonary circulation of blood in the human body.

Amputations Due to Landmine and Unexploded Ordnances in Post-war Iran

Abstract: Background: In view of lack of comprehensive data on landmine casualties that lead to amputation in Iran, we conducted this study to determine the pattern and demographic features of landmine explosions that result in amputation of the victims. Methods: To define the pattern of landmine- and unexploded ordnances-induced amputations and to understand the most common types of underlying activities at the time of the blast, a retrospective study was conducted among the victims in 5 western provinces of Iran, West Azerbaijan, Kermanshah, Kurdistan, Ilam, and Khuzestan between 1988 and 2003. Results: Of a total of 3713 victims, 1499 had undergone amputations. The mean age of the victims at the time of accident was 23 years; 92% of the victims were male, 48.4% of them were of very poor education and all were civilians. Below knee amputation was the commonest type of amputation. Conclusion: The occurrence of lower limb amputations from landmine injuries in Iran is a significant burden on the healthcare system; rendering allocation of more resources to provide preventative and rehabilitation measures is therefore a must. Archives of Iranian Medicine, Volume 11, Number 6, 2008: 595 – 597.

Gondishapur School of Medicine: the most important medical center in antiquity.

Abstract: Iran has a rich civilization and a long history during which medical science flourished at specific periods. For instance, medicine blossomed in Sassanids era (226 - 652 AD). One of the most remarkable cultural and scientific centers of Sassanids era was the city of Gondishapur located in the south-west Iran in Shah-Abad near Susa in Khuzestan Province. The city was rebuilt in the third century AD, whereupon it soon became the most important scientific focal point of the ancient world. Gondishapur Medical School was a renowned cosmopolitan institution and had a crucial impact upon the further development of Islamic medicine. Actually, at this school, the Greek, Persian, and Indian medical heritage was conserved, developed, and it was then transferred to the Islamic world and subsequently to the West. Gondishapur Hospital was also an excellent model for establishment of hospitals especially in the Islamic countries. Presented here is a brief account of the foundation of Gondishapur School of Medicine and its role in promoting medical science in antiquity.