Archives of Iranian Medicine
Volume:12 Issue: 3, may 2009

Hepatitis B virus infection is a very common cause of chronic liver disease worldwide. It is estimated that 3% of Iranians are chronically infected with hepatitis B virus. Current population-based studies on both rural and urban prevalence of hepatitis B virus infection in Iran are sparse with results that do not always agree. We performed this study to find the prevalence of hepatitis B surface antigen, anti-hepatitis B core antibody, and associated factors in the general population of three provinces of Iran. We randomly selected 6,583 subjects from three provinces in Iran, namely Tehran, Golestan, and Hormozgan. The subjects were aged between 18 and 65 years. Serum samples were tested for hepatitis B surface antigen and anti-hepatitis B core antibody. Various risk factors were recorded and multivariate analysis was performed. The prevalence of hepatitis B surface antigen and anti-hepatitis B core antibody in Iran was 2.6% and 16.4%, respectively. Predictors of hepatitis B surface antigen or anti-hepatitis B core antibody in multivariate analysis included older age, not having high-school diploma, living in a rural area, and liver disease in a family member. We did not find any significant differences between males and females. In spite of nationwide vaccination of newborns against hepatitis B virus since 1992, hepatitis B virus infection remains a very common cause of chronic liver disease in Iran which should be dealt with for at least the next 30 – 50 years.

Water pipe smoking is increasing in Eastern Mediterranean Region. The objective of this study was to investigate any relationship between water pipe smoking and health-related quality of life in the general population of Bandar Abbas, Iran. Using a multistage sampling method, a random sample of 1675 individuals aged 15 years and over was studied from June through July 2007. All eligible participants were interviewed using the Short Form Health Survey (SF-36) questionnaire and a short questionnaire containing items regarding socio-demographic characteristics and water pipe smoking status. To compare SF-36 scores between water pipe smokers and nonsmokers, t-test was performed. In addition, multiple logistic regression analysis was used to determine the influence of water pipe smoking on SF-36 scores after adjusting for other independent variables. In all, 1675 individuals were studied. The mean age of the respondents was 42.1 (SD=16.5) years. One hundred and seventy-two participants (10.4%) were water pipe smokers. There were statistically significant differences between water pipe smokers and nonsmokers on all scales except for role emotional (P<0.001). Logistic regression analysis showed that using water pipe was a risk factor for decreasing Physical Component Summary and Mental Component Summary scores [OR (95% CI): 2.15 (1.56 – 2.96), P<0.01; and OR (95% CI): 1.88 (1.36 – 2.60), P<0.01, respectively]. The study findings indicated that people who smoked water pipe carried a higher risk for poorer health-related quality of life

Hepatitis delta virus is a unique human pathogen responsible for some 20 million infections globally. This virus is dependent on hepatitis B virus for transmission and propagation. Currently, at least three genotypes of hepatitis delta virus with different geographic distribution and clinical manifestations are described. In this study, hepatitis delta virus RNA of 35 patients’ sera were analyzed by RT-semi-nested polymerase chain reaction. Based on genomic differences of hepatitis delta antigen coding region of hepatitis delta virus RNA among hepatitis delta virus RNA-positive sera, the polymerase chain reaction products were digested with restriction enzymes and studied by restriction fragment length polymorphism. Out of 35 samples, 13 (38.46%) were positive for hepatitis delta virus RNA by RT-semi-nested polymerase chain reaction. All polymorphisms were shown to be genotype I. Out of 13 hepatitis delta virus RNA-positive (13/35), eight were HBeAg negative. Our data indicated that hepatitis delta virus isolates in Tehran are exclusively genotype I.

The 6.3 Richter earthquake in Bam killed 26,000 and injured 30,000 people, and destroyed 85% of houses according to the literature. Children are affected more than others by disasters. In this study, we assessed the rate of post-traumatic stress disorder and psychological problems in survived Bam students in Kerman four months after the earthquake and their relations with demographic factors, family loss, house destruction, and body injury. A group of 433 students attended this cross sectional study. Watson post traumatic stress disorder questionnaire and Symptom Checklist-90 were applied for students older than 15 years of age and Yule post-traumatic stress disorder and Rutter (parents'' version) questionnaires were used for students younger than 15. Multiple regression analysis was used to assess the effects of variables on psychopathologies. Post-traumatic stress disorder was detected in 36.3% of the students older than 15 years of age and 51.6% of the students younger than 15. Behavioral problems were present in 31.3% of the children and the mean score of Global Symptom Index was 1.13±0.59. Body injury and living with family were correlated with post-traumatic stress disorder and Symptom Checklist-90 items in students older than 15. Female sex was correlated with post-traumatic stress disorder and behavioral problems in students younger than 15. The prevalence of post-disaster post-traumatic stress disorder was high in children. Younger age, female gender, living apart from family, geographic living conditions, being in the center of stress or not after the earthquake, body injury, and loss of family members form the basis for developing post-disaster psychopathology. Due to incomplete presence of post-traumatic stress disorder criteria or high rate of overlooking post-traumatic stress disorder in children, the disorder may be misdiagnosed or remain undiagnosed in them, which warrants more consideration

Increased prevalence of various vascular diseases is common in type 2 diabetes mellitus. However, the increased prevalence of renal artery atheroma resulting in renal artery stenosis in patients with diabetes mellitus has not been fully assessed. We used magnetic resonance angiography to assess the prevalence of renal artery stenosis in a group of patients with hypertension and type 2 diabetes mellitus and compared them with a group of hypertensive patients without diabetes. One hundred and seventy-three individuals were recruited consecutively in this study. They were divided into two groups: 50 patients with known type 2 diabetes and coexistent hypertension in group A and 123 hypertensive patients without diabetes in group B. All the patients underwent magnetic resonance angiography of the renal arteries to assess the presence of renal artery stenosis. The prevalence of renal artery stenosis in groups A and B was 44% and 35.8%, respectively (P=0.402). However, there was a significant association between the age and renal artery stenosis (P=0.023). Diabetes mellitus was not associated with the increased prevalence of renal artery stenosis in our study.

Measurement of lung volumes, especially residual volume and total lung capacity are essential for assessment of restrictive lung disorders. Information regarding normative prediction values for lung volumes as measured by body plethysmography is scarce, and plethysmographic parameters are believed to be poorly reproducible. In this study, we report a comprehensive set of predictive equations for static lung volumes from a general population sample of urban Iranians as measured by body plethysmography. Standardized measurements were carried out on 1487 healthy nonsmoking volunteers (845 men and 642 women), aged six to 85 years, living in Isfahan, Iran. Nonlinear multiple regression analysis was used to calculate prediction equations based on subjects'' ages and heights for the subdivisions of lung volumes [total lung capacity, functional residual capacity, residual volume, and residual volume/total lung capacity (%)], separately for the two genders. The derived equations were used to calculate prediction values for the subjects. The two sets of predicted and measured values were compared by paired sample t-test. Prediction equations based on a new nonlinear model, (α1×age+α2×agen+β× height+c) which best fitted our data are presented. The measured and predicted values closely resemble and there is no significant difference between the two sets. Since increments in total lung capacity, functional residual capacity, and residual volume disclose air trapping within the lungs, their upper limits of normal are as important as the lower limits. So, we have presented both for the equations. Despite the usual beliefs we found rather reproducible prediction equations with high coefficient of determination (r2) and low standard error of estimate (SEE) in Iranian population

Measurement of lung volumes, especially residual volume and total lung capacity are essential for assessment of restrictive lung disorders. Information regarding normative prediction values for lung volumes as measured by body plethysmography is scarce, and plethysmographic parameters are believed to be poorly reproducible. In this study, we report a comprehensive set of predictive equations for static lung volumes from a general population sample of urban Iranians as measured by body plethysmography. Standardized measurements were carried out on 1487 healthy nonsmoking volunteers (845 men and 642 women), aged six to 85 years, living in Isfahan, Iran. Nonlinear multiple regression analysis was used to calculate prediction equations based on subjects'' ages and heights for the subdivisions of lung volumes [total lung capacity, functional residual capacity, residual volume, and residual volume/total lung capacity (%)], separately for the two genders. The derived equations were used to calculate prediction values for the subjects. The two sets of predicted and measured values were compared by paired sample t-test. Prediction equations based on a new nonlinear model, (α1×age+α2×agen+β× height+c) which best fitted our data are presented. The measured and predicted values closely resemble and there is no significant difference between the two sets. Since increments in total lung capacity, functional residual capacity, and residual volume disclose air trapping within the lungs, their upper limits of normal are as important as the lower limits. So, we have presented both for the equations. Despite the usual beliefs we found rather reproducible prediction equations with high coefficient of determination (r2) and low standard error of estimate (SEE) in Iranian population.

The scientific output of Iran is increasing rapidly during the recent years. Unfortunately, most papers are published in journals which are not indexed by popular indexing systems and many of them are in Persian without English translation. This makes the results of Iranian scientific research unavailable to other researchers, including Iranians. The aim of this study was to evaluate the quality of current web-based databases indexing scientific articles published in Iran. We identified web-based databases which indexed scientific journals published in Iran using popular search engines. The sites were then subjected to a series of tests to evaluate their coverage, search capabilities, stability, accuracy of information, consistency, accessibility, ease of use, and other features. Results were compared with each other to identify strengths and shortcomings of each site. Five web sites were indentified. None had a complete coverage on scientific Iranian journals. The search capabilities were less than optimal in most sites. English translations of research titles, author names, keywords, and abstracts of Persian-language articles did not follow standards. Some sites did not cover abstracts. Numerous typing errors make searches ineffective and citation indexing unreliable. None of the currently available indexing sites are capable of presenting Iranian research to the international scientific community. The government should intervene by enforcing policies designed to facilitate indexing through a systematic approach. The policies should address Iranian journals, authors, and indexing sites. Iranian journals should be required to provide their indexing data, including references, electronically; authors should provide correct indexing information to journals; and indexing sites should improve their software to meet standards set by the government.

Psoriatic arthritis is defined as an inflammatory arthritis associated with psoriasis and is classified as a seronegative HLA-B27-associated spondyloarthropathy. We aimed to study the clinical and paraclinical presentations of psoriatic arthritis in 150 Iranian patients. Demographic, clinical, and paraclinical data obtained from 150 patients enrolled in a retro- and introspective study were analyzed. The female:male ratio was 1.11:1. The mean age at the onset of arthritis was 33.3 years. Arthritis occurred after psoriasis in 73%, preceded it in 17%, and simultaneously in 10% of the patients. The patterns of joint involvement were asymmetric oligoarthritis (46%), polyarthritis (5%), axial involvement (16%), distal interphalangeal joint involvement (23%), and mutilating arthritis (2.2%). There was no correlation between distal interphalangeal joint involvement and nail disease (P=0.33). Polyarthritis was more common in women (P=0.03) and axial involvement was more in men (P=0.02). Patients with spondylitis were younger at the disease onset (P<0.02). Dactylitis was seen in 12% of the patients. Enthesopathy (20.7%) was more common in patients with axial involvement (P=0.008) and joint deformity (15%) was more common in patients with polyarthritis or distal interphalangeal joint involvement (P<0.0002). Four patients had ocular inflammation. Anemia was detected in 24%, high erythrocyte sedimentation rate in 79%, and abnormal urinary indices in 9% of the patients. There was a significant correlation between HLA-B27 (16%) and axial involvement (P=0.01) as well as joint erosions (16%) and distal interphalangeal joint involvement (P<0.0001). Thirty-four patients (26.8%) showed radiographic findings of sacroiliitis, while only 14 of them had axial involvement. Oligoarthritis was the most common type of joint involvement in these Iranian patients. We found no correlation between distal interphalangeal joint involvement and nail changes, although it was seen with more erosive changes and joint deformity. In comparison with other studies, extra-articular manifestations were not common in our patients.

Major thalassemia is one of the most common hemoglobinopathies in many Asian countries including Iran. Pharmacologic agents such as hydroxyurea have been known to enhance the production of fetal hemoglobin, and also an increase in total hemoglobin level has been repeatedly reported during hydroxyurea treatment in patients with sickle cell disease and in several patients with intermediate beta-thalassemia. We evaluated the long-term efficacy and safety of hydroxyurea in major beta-thalassemic patients.Forty-nine beta-thalassemic patients enrolled in the study. The mean follow-up time was 60 months. The mean dose of hydroxyurea was 10 mg/kg per day (8 – 15 mg/kg). Before starting hydroxyurea, all patients underwent routine biochemical laboratory tests. Patients with low platelet count (<100,000/mm3), neutropenia (polymorphonuclear neutrophil<1,200/mm3), pregnancy,and on interferon treatment were excluded.Twenty-eight out of 49 enrolled patients were females with the mean age of 18.38 years (10 – 40 years). The mean packed red cell transfusions during one year before starting of hydroxyurea was 22.75 units which decreased to 6.02 units after treatment (P<0.01). The mean ferritin level during the first period was 2751.44 ng/mL, but decreased to 1594.20 ng/mL after one year of hydroxyurea therapy (P<0.001).We observed a substantial and persistent increase in hemoglobin level and a significant decrease in blood transfusion. Hydroxyurea treatment was well-tolerated and it did not cause any hematopoietic suppression except in one patient who developed transient thrombocytopenia which resolved after short period of hydroxyurea cessation. We did not encounter any malignancies including leukemia in the five-year follow-up.

We aimed to investigate the attitudes of healthcare providers towards patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in Bandar Abbas, south of Iran. In this cross-sectional study, a random sample of 250 healthcare providers completed a 20-item questionnaire from January first through February 30th, 2007. There were five domains of attitudes towards patients with HIV. The items measured as a five-point Likert scale ranging from strongly disagree to strongly agree. The mean age of the healthcare providers was 31.3 (SD=7.3) years. Of them 24.4% were males, 42.4% had received Bachelor of Science degree, 19.2% were physicians, 63.2% were nurses, and 17.6% were laboratory technicians. The respondents had fairly positive attitudes towards patients with HIV. Men, older age, more educated participants, and laboratory technicians had more favorable attitude towards HIV (P<0.05).

Desmoplastic ameloblastoma is an unusual type of ameloblastoma with special histologic and radiographic features and anatomic distribution which differs from those in the classic type of ameloblastoma. The purpose of this article is to assist the dental community in better understanding of this variation of odontogenic tumor. We present a patient with desmoplastic and conventional variant of ameloblastoma (hybrid lesion) localized in the anterior portion of the mandible. The tumor was expansile and painless. The radiographic finding showed an ill-defined mixed (radiopaque/radiolucent) lesion between roots of the lower left canine and the lateral incisor. Marginal resection was performed. Follow-up examination one year later revealed no recurrence of the tumor. Desmoplastic variant of ameloblastoma tends to infiltrate between bone trabeculae. Curettage leaves islands of the tumor within bone, which later manifest as recurrences. Therefore, for big lesions en bloc excision is the most widely used treatment to avoid recurrence.

Calcifying odontogenic cyst is a rare lesion representing about 1% of jaw cysts. It may occur in a central (intraosseous) or peripheral (extraosseous) location.A case of peripheral calcifying odontogenic cyst located on the gingiva, appearing as a painless, circumscribed, sessile, and pink to red nodule has been reported.Peripheral, in contrast to central, calcifying odontogenic cyst tends to affect older patients. Peripheral calcifying odontogenic cyst is a less aggressive lesion than the central counterpart, and a simple excision biopsy is curative.The histologic findings of an epithelium rich in ghost cells has helped in making the diagnosis.

A 37-year-old man, a known case of Behcet''s disease with its vascular complications such as abdominal and thoracic artery aneurysms, was admitted with the diagnosis of acute anterior myocardial infarction and received thrombolytic therapy. Coronary angiography and percutaneous coronary intervention via transradial approach were performed for the patient on the eighth day of admission. The patient did not suffer from any symptoms, myocardial infarction, or readmission in the nine-month follow-up. About 25 cases of myocardial infarction associated with Behcet''s disease have been reported previously. Although coronary involvement is rare in Behcet''s disease, it is especially important because it affects young individuals and often presents as acute coronary syndromes.

Celiac disease is an autoimmune disease associated with increased risk of several diseases including a variety of malignancies. This is the first report of the concomitance of atopic dermatitis and Hodgkin’s lymphoma in a child with celiac disease. Here, we report an 11-year-old boy with chronic diarrhea, glossitis, chronic dermatitis, and megaloblastic anemia who later developed Hodgkin''s lymphoma.

Nemazee Hospital in Shiraz, Fars Province, in southern Iran is a well-equipped modern hospital, which was founded in 1955. It is one of the greatest memorials of a Shirazi beneficent merchant, the late Haj Mohammad Nemazee (1895 – 1972), who dedicated much of his wealth to charitable affairs in his birthplace.This paper briefly explores the history of the establishment of Nemazee Hospital in Shiraz.