ARCHIVES OF IRANIAN MEDICINE
Year:2010 | Volume:13 | Issue:2|Papers Count:16

Background: Since the declaration of a swine flu pandemic by the World Health Organization (WHO), the Islamic Republic of Iran has launched a surveillance system to test all suspected cases, both in community and hospital settings.Patients and Methods: From June 1st to November 11th, 2009, there were 2662 (1307 females and 1355 males) RT-PCR confirmed cases of pandemic influenza A (H1N1) detected in Iran. Of these cases, 75% were 5 – 40 years-old. During this period, 58 patients (2.18%) died. Of the total number of cases, 33 were pregnant women with no reported mortalities amongst them. The prevalence of death had no significance correlation with sex and age (P=0.720 and 0.194, respectively).Results: Geographic distribution of the reported cases showed the highest rates in central and eastern provinces of Iran. There were two disease phases until November 2009, including an initial exogenous wave which blended into a second wave of indigenous disease, with a peak of cases after the start of the educational year. A review of the epidemiology of these initial phases of disease in Iran can help for better planning and more efficient action in future phases of the disease.Conclusion: It is of utmost importance to strengthen the surveillance system for this disease and appropriately transfer the resultant knowledge to the medical professionals, stakeholders and the general population, accordingly.

Background: In older studies, the seroprevalence of hepatitis A virus infection has been reported tobe over 95% in Iranians. Most of these studies were performed on volunteer blood donors. Studies on the general population are sparse. The purpose of this study was to determine the current seroprevalence of hepatitis A virus infection in the general population of Iran.Methods: During 2006, 1869 subjects between 18 and 65 years of age were randomly selected from the general population of three Iranian provinces (Tehran, Golestan, and Hormozgan). Subjects were interviewed and a plasma sample was obtained for serologic testing for antihepatitis A virus. Univariate and multivariate analysis was performed to identify risk factors. Results: The seroprevalence of hepatitis A virus in Tehran, Golestan and Hormozgan was 85%, 99%, and 96%, respectively. The overall seroprevalence of hepatitis A virus in the general population of the three provinces studied was 86% and did not differ between the two genders. The prevalence in younger subjects and in urban populations was under 70%. In multivariate analysis, older age, being married, and level of the father’s education was associated with hepatitis A virus seropositivity.Conclusion: The seroprevalence of hepatitis A virus still appears to be too elevated for recommending routine vaccination in the general population. However, the trend towards a lower prevalence in younger age groups and people from urban areas points towards the possible benefit of vaccination in these subgroups.

Background: Melatonin, found in high concentrations in the pineal gland, organs within the digestive system and in some plants and fungi, acts as an antioxidant which decreases reactive oxygen species in streptozocin-induced diabetic rats, raises insulin secretion by the pancreatic b-cells and increases the number of insulin receptors on hepatocyte membranes.Materials and Methods: The protective and therapeutic effects of melatonin feeding in streptozocin-induced diabetic rats were studied. Streptozocin administered rats were gavaged with melatonin, pre- and post-treatment, at a level of 5 mg/kg body weight daily for a period of 15 days.Levels of plasma glucose, cholesterol, triacylglycerol, oral glucose tolerance test, and some hepatic enzymes of carbohydrate metabolism including insulin inducible glucokinase, hexokinase and glucose 6-P dehydrogenase were measured using standard methods and compared with the values in normoglycemic and diabetic control groups.Results: Both pre- and post-treatment of the streptozocin administered rats with melatonin normalized plasma glucose, cholesterol, and triacylglycerol, improved oral glucose tolerance test and increased hepatic glucokinase, hexokinase and glucose 6-P dehydrogenase specific activities to the levels seen in normal rats.Conclusion: Melatonin pre-treatment prevents the injurious effects of streptozocin in rats. In streptozocin induced diabetic animals, post-treatment with this antioxidant normalizes both blood and liver constituents which were ameliorated by streptozocin.

Background: Golestan Province in north-eastern Iran has one of the highest incidence rates for esophageal squamous cell carcinoma (ESCC) worldwide. Earlier studies have reported higher incidence rates in the areas of Golestan which are mainly inhabited by individuals of the Turkmen ethnic group. However, it is not clear whether in those areas the incidence among Turkmens is higher in comparison to non-Turkmens. Some previous studies have suggested that environmental factors might play a more essential role in ESCC carcinogenesis in Golestan than a genetic background. If environmental factors instead of a genetic background are the major risk factors, therefore the prevalence of known environmental risk factors would not significantly differ among ESCC cases of different ethnic groups. To investigate the role of environmental factors versus genetic background by using the above concept, we have compared the prevalence of known risk factors for ESCC among Turkmen and non-Turkmen ESCC cases.Methods: Study participants were histopathologically proven ESCC cases from Golestan Province. They were recruited in the study from December 2003 to June 2007. The prevalence of the most important known risk factors for ESCC in Turkmen and non-Turkmen ESCC cases was compared using Chi-squared and Fisher’s exact tests.Results: Of 300 ESCC cases recruited in the study, 171 (57.0%) and 129 (43.0%) cases were Turkmen and non-Turkmen, respectively. In the majority of the investigated risk factors which included tobacco, nass, and opium use, hot and extremely hot tea consumption, as well as decreased levels of education; there was no significant difference between Turkmen and non-Turkmen ESCC cases in the prevalence of exposure.Conclusion: Our findings support the suggestion that a substantial difference between Turkmens and non-Turkmens in terms of genetic susceptibility to ESCC is unlikely. Nevertheless, the moderate effect of genetic factors cannot be ruled out. Further studies to investigate potential environmental and genetic risk factors of ESCC in Golestan and the interaction between environmental and genetic factors are warranted.

Background: Recently there are a number of reports on the cardiotoxicity of tacrolimus in post-transplant patients. There is no protocol for cardiovascular evaluation in these patients. This study was performed to evaluate the cardiotoxicity of tacrolimus in liver transplant recipients.Patients and Methods: We evaluated 63 post-liver transplant patients who received tacrolimus. They were evaluated for cardiovascular complications by physical examination, electrocardiographic and echocardiographic examinations within three and six months following liver transplantation. Serum tacrolimus levels were checked by ELISA. For comparison, we selected 50 post-liver transplant patients who received no tacrolimus and evaluated them for cardiovascular function identically.Results: Among 63 patients, 42 were male (66.7%) and 21 were female (33.3%); 70% of the patients were adults, and 19 (30%) were within the pediatric age group. The cardiovascular examinations, electrocardiogram and echocardiography of all patients three months post transplantation were normal except for two children who developed tacrolimus related cardiac complications. Both had high serum tacrolimus levels. No adults developed cardiovascular complications. In the control group, the results of the cardiovascular evaluations were normal in all cases. Conclusion: The cardiovascular toxicity of tacrolimus, such as hypertrophic cardiomyopathy, may be observed in pediatric patients. Therefore, we recommend routine regular cardiovascular evaluation of children after liver transplantation.

Background: Serotonin (5HT) has been shown to be a mitogenic factor in several carcinomas. Its mitogenic effect is elicited through a wide range of 5HT receptor subtypes. In this study, the effects of 5HT, 5HT3 (1-phenylbiguanide hydrochloride) and 5HT4 (cisapride) agonists in promoting the growth of the HT29 cell line and the growth-inhibition effect of the 5HT3 receptor antagonist (Y-25130 hydrochloride) and 5HT4 receptor antagonist (RS 23597-190) were investigated. The expressions of 5HT3 and 5HT4 receptors in human colon cancer tissues and the HT29 cell line were studied. Methods: The growth-promoting and growth-inhibition effects of 5-HT, 5HT3 and 5HT4 agonists and antagonists on the HT29 cell line were studied using MTT assay. Receptor expression has been demonstrated by western blotting.Results: The results showed that 5HT, 5HT3, and 5HT4 agonists caused significant proliferation of HT29 cells. 5HT3 and 5HT4 receptor antagonists had an inhibitory effect on the growth of these cells. Western blot analysis gave bands from colon tissue extracts and the HT29 cell line.Conclusion: The results indicate which 5HT3 and 5HT4 receptors are significantly expressed in both colon cancer tissue and the HT29 cell line. Expression for the 5HT3 receptor is more potent.Furthermore, 5HT plays a mitogenic role in colon cancer cells and antagonists of 5HT3, and 5HT4 receptors can inhibit cancer cell growth.

Introduction: Bispectral Index is an objective tool to assess electroencephalographic activity and measure the effect of certain sedatives and hypnotics on the brain. In addition, there are certain subjective tools such as the observer's assessment of alertness and sedation which are used. The correlation between BIS and the concentration of propofol in the brain, and the relationship between these subjective and objective tools in assessing sedation levels are the subject of this study.Methods: Thirty healthy volunteers enrolled in this prospective observational study. They were sedated with a target controlled infusion of propofol with an initial target of 0.8 mg.mL-1 and an increase in target to 0.2 mg.mL-1 ten minutes after equilibration of the predicted and set target concentrations. In each sedation score, the Bispectral Index value and predicted effect site concentration of propofol were recorded and analyzed. Analysis of variance and significant differences between groups were analyzed by paired t-test. Correlations between Bispectral Index and effect site concentration of propofol at each sedation score and the relationship of BIS and effect site concentration of propofol to each sedation score were assessed and analyzed by nonparametric Spearman's rho (p).Results: The means of Bispectral Index and effect site concentration of propofol at each sedation score showed a significant difference with the following score. Additionally, Bispectral Index and effect site concentration of propofol showed a significant negative correlation in sedation scores 3 and 2 when inducing sedation. In other sedation scores or when reversing the sedation, no strong correlation was noted.Conclusion: Both Bispectral Index and effect site concentration of propofol indicate a good estimate of sedation levels; however their correlations are significant and negative only at moderate and deep sedation levels, and during the induction of sedation.

Background: Soluble Fas (sFas) is a marker of apoptosis that appears to increase in the serum of systemic lupus erythematosus patients and may have a correlation with disease activity.The exact role of sFas in apoptosis is not clear. The purpose of this study is to assess the correlation between serum levels of soluble Fas (Apo/1-CD95) and the activity of systemic lupus erythematosus. Patients and Methods: Our study was performed on 114 systemic lupus erythematosus patients who were compared with 50 randomly selected sex, age and race-matched healthy controls. Disease activity was defined according to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K). All physical exams and laboratory parameters were collected to determine the SLEDAI. sFas levels were determined using a commercially available ELISA kit. Results: There was a significant difference between serum levels of sFas in the case and control groups (P=0.001). A significant correlation coefficient existed between the sFas and SLEDAI2K variables (P=0.001, r=0.494). Significant statistical difference was found between serum levels of sFas in the active and inactive phases of disease according to SLEDAI£ 9 or ³10, (P=0.002). The sFas levels were 270 – 300 pg/mL for SLEDAI£9 and 355-502 pg/mL for SLEDAI³10, with a confidence interval of 95%.Conclusion: This study shows a significant elevation of sFas levels in the sera of systemic lupus erythematosus patients with active disease; therefore it can be used as an appropriate marker for evaluation of disease activity.

Iran as a developing nation is in epidemiological transition from communicable to noncommunicable diseases. Although, cancer is the third cause of death in Iran, it`s mortality are on the rise during recent decades. This mini-review was carried out to provide a general viewpoint on common cancers incidence in Iran and to explain incidental differences that may help us to establish early detection programs and investigate population risk factors. A detailed Pub Med, Scopus and Google scholar search were made from 2000 to 2009. The basic inclusion criteria were all relevant studies focused on cancer epidemiological data from Iran. Overall age-standard incidence rate per 100,000 populations according to primary site is 110.43 in males and 98.23 in females. The five most common cancers (except skin cancer) are stomach, esophagus, colon-rectum, bladder and leukemia in males, and in females are breast, esophagus, stomach, colon-rectum and cervix uteri. The incidence rates of gastrointestinal cancers are high in Iran (it is one of the known areas with a high incidence of GI cancers). Breast cancer mainly affects Iranian women about a decade earlier than Western countries and younger cases are affected by an increasing rate of colorectal cancer in Iran, near the Western rates.

Asymptomatic hepatitis B infection is characterized as a type of hepatitis in which hepatitis B surface antigen is present in the patient’s peripheral blood despite the absence of clinical symptoms. Previous studies have shown that a particular genotype may affect clinical manifestations of hepatitis B infection; hence, the aim of the current study was to determine the frequency of hepatitis B virus genotypes among asymptomatic carriers of hepatitis B. In this experimental study, the plasma samples of 100 asymptomatic carriers were collected and tested for HBsAg and anti-HBs using ELISA. The genotype of hepatitis B virus was determined by the GAP-PCR technique.The results of this study showed that all samples were positive for hepatitis B surface antigen and anti-hepatitis B core antigen was present in 60 (60%) cases. Our results also indicated that all patients had the D genotype of hepatitis B virus.

Foreign Body Aspiration can be a life threatening event especially for young children with smaller diameters of airway size. The foreign body can result in body response and granulation tissue formation around the object which makes the foreign body removal difficult. In such situations surgical intervention is usually needed but with interventional pulmonology modalities we can restrict the need of surgery.

Less than 1% of basal cell carcinomas are giant basal cell carcinomas. Giant basal cell carcinomas are rare. They preferentially involve the trunk and are commonly associated with neglect. Giant basal cell carcinomas of 10 cm or greater are associated with a high rate of metastasis. We report a case of giant basal cell carcinoma of the leg which is not associated with neglect and no signs of metastasis, despite being more than 10 cm in diameter. The present paper includes a brief review of the literature.

During 1988 – 1994 a total of 38 cases of human anthrax were admitted to Sina Hospital in Kermanshah (western Iran). There were two cases of gastrointestinal anthrax (5.3%) with culture positive ascitic fluid. Among the many reported gastrointestinal signs and symptoms, unexpectedly one of our patients had only vomiting and ascites whereas the other case had only ascites. Neither had abdominal pain, tenderness, diarrhea, hematemesis, melena, or other expected signs and symptoms of anthrax. Therefore, in contrast to the available reports, these cases presented atypically and despite receiving a sufficient dose of penicillin, the drug of choice at that time, both patients died.Gastrointestinal anthrax is not as rare as reported but due to an unusual presentation it may be misdiagnosed. Paying attention to gastrointestinal anthrax in the differential diagnosis of ascites with unknown origin and other gastrointestinal presentations in endemic areas may help to diagnose more cases of anthrax. Timely appropriate management in an early stage of the disease, may increase their chances of survival.

Medical philately provides a useful medium for the study of medical history. There are a handful of Iranian stamps which have been issued with a medical theme. This report briefly reviews the history of Iranian medicine through Iranian commemorative postage stamps. Some notable stamps are presented.

The Rheumatology Division in the Department of Internal Medicine at Shiraz University of Medical Sciences) (former Pahlavi University) (was established by Dr. Ali-Asghar Eghtedari in 1970. Drs. Mohammad Salami and Hadi Hedayati joined this division in 1973 and 1974, respectively. Since 1980, Dr. Akbar Rajaee has been in charge of this division. In 1986, the rheumatology subspeciality training program at Shiraz University of Medical Sciences was approved by the Ministry of Health.

A 37-year-old man presented with symptoms presumably related to peptic ulcer disease. Further workup, however, including ultrasonography and CT scan, demonstrated multiple hepatic nodules (Figure 1). His past medical and drug histories were both unremarkable. Most of the routine laboratory tests proved to be normal, except for a WBC count of 14200 cell/mL and a serum alkaline phosphatase level of 760 U/L (normal range in adults: 40 – 140 U/L)….