Archives of Iranian Medicine
Volume:11 Issue: 6, Nov 2008

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. 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. 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. 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.

The aim of this study was to evaluate serum lipid profiles and the prevalence of dyslipidemia in schoolchildren in south Khorasan Province. The participants of this cross-sectional study were 685 girls and 641 boys, aged seven to 12 years, selected by multistage random cluster sampling from urban and rural areas of south Khorasan Province (eastern Iran). Fasting blood samples were analyzed for total cholesterol, low-density lipoprotein cholesterol, triglycerides, and high-density lipoprotein cholesterol. The mean values of total cholesterol and low-density lipoprotein cholesterol were significantly higher in girls. There was no significant correlation between the mean values of serum lipids with age of the children. The mean values of triglyceride and high-density lipoprotein cholesterol were significantly higher and lower, respectively, in rural areas. In all the participants, the percentiles of triglycerides were higher and the percentiles of high-density lipoprotein cholesterol were lower than standard values according to Lipid Research Clinics data. The most common form of dyslipidemia was decreased high-density lipoprotein cholesterol (14.1%). The prevalence of hypertriglyceridemia, increased low-density lipoprotein cholesterol, and hypercholesterolemia were 5.4%, 4.1%, and 3%, respectively. There was not any significant relation between different forms of dyslipidemia with age of the children. Decreased high-density lipoprotein cholesterol and increased low-density lipoprotein cholesterol were significantly more common in girls. The prevalence of decreased high-density lipoprotein cholesterol was significantly higher in rural than urban areas. Considering the high prevalence of dyslipidemia and undesirable lipid profiles in the schoolchildren of eastern regions of Iran, it is strongly recommended to search for underlying factors.

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. 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 95th percentile. 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). 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.

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. 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. 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. 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.

Genetic polymorphism of CYP2A6 gene is a major causal factor in the large interindividual differences in nicotine metabolism. It may have an impact on smoking behavior and smoke-related cancer susceptibility. Until now, there are no reports of CYP2A6 allele frequencies in Iranian population. In the present study, we investigated the frequencies of CYP2A6 alleles in 250 male Iranians. CYP2A6*2, CYP2A6*4, CYP2A6*9, and CYP2A6*12 were determined by allele-specific polymerase chain reaction. Frequencies of *2, *4, *9, and *12 alleles were 2.2%, 0.95%, 12.4%, and 1.34%, respectively. These results showed that the distribution of CYP2A6 alleles in Iranian population was different from those reported previously for other ethnic groups. This highlights the importance of conducting further studies to investigate the implications on smoking dependence and cancer in Iranians.

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. 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. 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. 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.

Behçet’s disease is a chronic, multisystemic disease of unknown etiology in which eye involvement is the most common cause of morbidity. In this study, we investigated the possible relation between serum homocysteine level and ocular involvement in patients with Behçet’s disease. One hundred and fifty patients who fulfilled the criteria of the International Study Group for Behçet’s disease (96 females and 54 males) were enrolled. All the patients were evaluated carefully by an experienced ophthalmologist for the diagnosis of ocular involvement. Serum homocysteine, vitamin B12, and folate levels were determined. The patients were categorized according to the presence or absence of uveitis. The data were statistically analyzed by using Student’s t-test and P values less than 0.05 were considered statistically significant. Fifty- nine patients (39.3%) had eye involvement, which included anterior uveitis, vitritis, macular damage, optic atrophy, panuveitis, posterior uveitis, retinal vasculitis, and retinal hemorrhage. Serum levels of folate and vitamin B12 were comparable in patients with Behçet’s disease. There was no significant correlation between serum homocysteine level in patients with and without eye involvement. Our findings suggest that homocysteine level does not have significant effect on eye involvement in patients with Behçet’s disease.

Lithium, a mood stabilizer, may exert adverse effects on memory. We have previously shown that lithium induces state-dependent learning. Cholinergic systems of the brain may play an important role in memory function and mood regulation. In the present study, the effects of intra-dorsal hippocampal (intra-CA1) injections of lithium and scopolamine on memory and cross state-dependent learning between the two drugs were investigated. For memory assessment, a one-trial step-down inhibitory avoidance task was used in adult male NMRI mice. Intra-CA1 administration of lithium (0.5 and 1 μg/mouse) after training or injection of the drug (0.5μg/mouse) before testing impaired memory when retrieval was tested 24 hours later. The memory impairment by post-training lithium was reversed by pretest administration of the drug (0.5μg/mouse, intra-CA1) suggesting lithium state-dependent learning. On the other hand, intra-CA1 administration of scopolamine (0.5, 1, and 2 μg/mouse) after training or injection of the drug (2μg/mouse) before testing impaired memory when retrieval was tested 24 hours later. The impairment of memory by post-training injection of scopolamine (2μg/mouse) was restored by the pretest injection of the drug (1 and 2 μg/mouse). Furthermore, memory impairment induced by post-training injection of lithium (0.5 μg/mouse) and scopolamine (2 μg/mouse) was reversed by pretest administration of scopolamine (0.5, 1, and 2 μg/mouse) and lithium (0.5 and 1 μg/mouse), respectively. The impairment by lithium was also reversed by physostigmine. The results suggest that microinjections of both lithium and scopolamine induce state-dependent memory and there may be a cross state-dependency between the two drugs.

Opioid drugs are considered as important members of drugs of abuse. Opioid abusers are more likely to be infected which may be due to apoptotic effects of the drugs on immune cells. Furthermore, there are some reports on the apoptotic effect of morphine on neural cells. In the present study, the effect of morphine and lithium on apoptosis in PC12 cell line (as a model of neural cells) was examined. We used 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, annexin V-fluorescein isothiocyanate test and quantitative real time RT-polymerase chain reaction for detection of necrosis and apoptosis (programmed cell death). PC12 cells were exposed to different concentrations of morphine for six, 12, 24, 48, and 96 hours. Quantitative real-time RT-polymerase chain reaction revealed that mRNA expression of BAX (proapoptotic element) increased while a decrement in the mRNA expression of BCL-2 (protective element) was observed after six hours (but not after 12 or 24 hours) exposure to morphine. Furthermore, the results of MTT assay and annexin V-fluorescein isothiocyanate test indicated that morphine exposure causes an increase in the percentage of apoptotic and necrotic cells, respectively. Interestingly, the results of MTT assay and annexin V-fluorescein isothiocyanate test were observed 12 and 24 hours after morphine exposure. Thus, it can be concluded that alteration in mRNA expression is an early event rather than as a consequence of apoptosis or necrosis. On the other hand, lower concentrations of lithium elicit protective effect against apoptosis in some of mammalian cells while the higher concentrations are toxic. Despite large body of evidences on the protective effect of lithium, elucidation of downstream events are still unknown. In the present study, 72-hour preincubation of PC12 cells with 1.2 mM lithium chloride reversed the effects of morphine on the mRNA expression of BAX and BCL-2. Furthermore, the results of real time RT-polymerase chain reaction were supported by annexin V-fluorescein isothiocyanate test and MTT assay. The protective effect of lithium on the morphine-induced cytotoxicity is mediated via down-regulation of BAX and up-regulation of BCL-2 mRNA expression.

Television as an external stimulation can precipitate epileptic seizures. Today this kind of epilepsy is known as television epilepsy. As children spend much of their time watching television, it is important to study this type of epilepsy in this age group. This study was designed to describe the clinical and some demographic characteristics of television epilepsy in Iranian children. Patients who were diagnosed as having television epilepsy with an age less than 12 years were recruited from outpatient neurology clinics in Isfahan, Iran, from September 2002 through September 2006. We collected the case-related information including electroencephalo-grams, radiologic findings, and patients'' history. Thirty patients with television epilepsy with the age less than 12 years were identified. Of whom 17 (56.7%) were females and 13 (43.3%) were males. The mean age at the onset of seizure was 9.9±2.1 years. Children had absence (3.3%), myoclonic (3.3%), and generalized tonic-clonic (93.3%) seizures in response to intermittent photic stimulations. Interictal epileptiform discharges in electroencephalograms were detected in 83.3%. In addition, neuroimaging findings were normal in 96.7% of the patients. In our study, 56.7% of the children had pure television epilepsy and 43.3% experienced other types of generalized seizure. During the follow-up period after initiation of variable drug treatments including valproic acid, carbamazepine, phenobarbital, clonazepam, ethosuximide, and lamotrigine all the patients had complete seizure remission. The clinical and demographic differences of our patients compared with other reports are probably due to genetic differences. In our study, it was demonstrated that carbamazepine could be used in children with television epilepsy because it had successfully terminated seizures in 43.3% of the patients.

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.

Celiac artery aneurysm associated with hemosuccus pancreaticus is extremely rare. We herein present a 67-year-old man with a large celiac artery aneurysm presenting with intermittent massive gastrointestinal bleeding due to connection of aneurysm with a blood-filled pancreatic duct who was successfully operated. To the best of our knowledge, this is the first report of a case of hemosuccus pancreaticus due to celiac artery trunk aneurysm.

Epididymo-orchitis is an uncommon complication of posterior urethral valve. A four-year-old boy was admitted because of right-sided epididymo-orchitis. Scintigraphy of the scrotum showed increased uptake of radiotracer on the right side. The posterior urethral valve was disclosed by voiding cystourethrography. Ablation of the valve and antibiotic therapy made the patient free of symptoms.

Synchronous development of gastrointestinal stromal tumors with other tumors in the digestive tract is relatively rare, and often occurs in the stomach. We report a 76-year-old woman, who suffered from the exceedingly rare synchronous development of small intestinal stromal tumor and cecal adenocarcinoma. The patient presented with intestinal obstructive symptoms. The pre-operative abdominal ultrasonography demonstrated a very large heterogenous periumbilical mass. Laparotomy was performed and the evaluation of the surgical specimen revealed a huge 14-cm subserosal mass of high risk ileal stromal tumor along with cecal adenocarcinoma with regional lymph node metastasis. The patient died within 3 months of diagnosis.

The resurgence of Islamic Civilization in the Near East in the 7th 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 about early Islamic Medicine was carried out focusing on Persian physician-philosophers Zakariya Razi.Abu Bakr Mohammad Ibn Zakariya al-Razi, known in the West as Rhazes, was born in 865 AD in the ancient city of Rey, Near Tehran. A musician during his youth he became an alchemist. He discovered alcohol and sulfuric acid. He classified substances as plants, organic, and inorganic. At age 30, he undertook the study of medicine. He was a prolific writer with more than 184 texts in medicine attributed to him with 40 of them currently available. Among them are Kitab al-Mansoori, Kitab al-Hawi, and Kitab al -Judari wa al-Hasabah. The latter is the first scientific description for the recognition and differentiation of smallpox and measles. The Bulletin of the World Health Organization of May 1970 pays tribute to Razi by stating “His writings on smallpox and measles show originality and accuracy, and his essay on infectious diseases was the first scientific treatise on the subject”. Razi established qualifications and ethical standards for the practice of medicine.Zakariya Razi was not only one of the most important Persian physician-philosophers of his era, but for centuries his writings became fundamental teaching texts in European medical schools. Some important aspects of his contributions to medicine are reviewed.