فهرست مطالب

Archives of Iranian Medicine
Volume:12 Issue: 6, Nov 2009

  • تاریخ انتشار: 1388/08/11
  • تعداد عناوین: 18
|
  • A. A. Haghdoost, M. M. Gooya, M. R. Baneshi Page 533
    Background
    This year’s new H1N1 flu strain has rapidly become a serious threat worldwide. This pandemic calls for urgent preparedness to mitigate its impact as much as possible. Employing this knowledge, we simulated a model of the outbreak of H1N1 in two cities of Iran (middle size: Kerman and metropolitan: Tehran).
    Methods
    We developed a compartmental model to predict the expected number of patients who might develop severe (S), very severe (VS) disease or die (D). We assumed that, in winter, the Basic Reproductive Number (R0w) would reach 1.6 in Kerman and 1.8 in Tehran, respectively. Corresponding figures in summer varied from 1.2 (R0sMin) to 1.4 (R0sMax) in Kerman and from 1.3 to 1.5 in Tehran. Moreover, we checked the effect of the number of imported infectious cases at the beginning of the outbreak based on predictions.
    Results
    A minimum lag of six months was observed between introduction of the virus (June 2009) and beginning of the outbreak (December 2009). The lag was sensitive to the number of infectious cases and the R0: a lower R0 postponed the peak. In Kerman, with R0sMax of 1.4, the number of S, VS, and D were 2,728, 546 and 468 respectively. Corresponding numbers in Tehran with R0sMax of 1.5 were 83,363, 16,673, and 14,291.
    Conclusion
    Since the number of S and VS cases would be crowded over a short period of time, the health care system most probably would not be able to provide appropriate services unless special measures are taken in advance. By reduction of R0 and the number of introduced infectious cases the peak of the outbreak might be postponed to the end of 2010. This would provide a golden opportunity to vaccinate a considerable proportion of the population.
  • M. Nojomi, M. F. Ghalhe Bandi, S. Kaffashi Page 542
    Background
    Sleep disturbances is a distressing and disabling condition that affects many people, and can affect on quality of work and education of medical students and residents. The objective of this study was to determine the prevalence of sleep disorders in medical students and residents.
    Methods
    A representative sample of medical students and residents of Iran University of medical students in Tehran, Iran, were assessed by a self-administered questionnaire. This study covers 400 medical students from the first to seventh year and residents from the first to the last year between December 2007 and February 2008. The questionnaire includes questions on demographic characteristics (6 questions), sleep/wake habits (6 questions), insomnia-related symptoms (4 questions), symptoms of parasomnia (6 questions), cognitive and psychomotor behaviors (6 questions), lifestyle (4 questions), self-perception of sleep satisfaction, and use of sleeping pills (2 questions).
    Results
    The sample included 135 (33.8%) pre-internship students, 150 (37.5%) interns, and 115 (28.7%) medical residents. Sleep satisfaction was reported as “perfect” in only 14%. 44% and 30% reported “good” and “fair” satisfaction. The use of sleeping pills in the previous 30 days was reported by only 3.3% of respondents. One hundred and three (25.7%) participants reported working while studying (sometimes to full-time). Between 43% and 48% of participants had gone to bed later than usual one to three times a week. About 14% of subjects reported snoring. The mean±SD of insomnia and parasomnia scales were 7.0±2.3 and 6.8±1.2, respectively. The mean of insomnia were more among females, subjects with noise in their living place, and students who worked full-time while studying, and was less in person who did exercise (P<0.05).
    Conclusion
    Sleep disturbances are an important issue among medical students and residents and associated with age, gender, living conditions, doing exercise, and workload.
  • N. Ashjazadeh, A. Zamani, M. Pourjafar, G. R. Omrani Page 550
    Background
    Chronic antiepileptic therapy has been associated with metabolic bone diseases including osteomalacia and osteoporosis. The object of this study was to assess the effect of first line anticonvulsants on bone density and vitamin D levels in Iranian ambulatory patients.
    Methods
    We conducted a cross-sectional study assessing bone density with dual energy X-ray absorptiometry at the hip and lumbar spine in 90 outpatients receiving anticonvulsants and 90 normal subjects matched for age, sex, and body mass index. Plasma total calcium, intact parathyroid hormone, total alkaline phosphatase in addition to 25 hydroxy vitamin D were also determined in both groups.
    Results
    The mean (±SD) bone density in patients treated with antiepileptic drugs was lower at the spine (T Score= -084±1.18 vs. -0.5±1.18, P< 0.05) and femoral neck (T Score= -0.83±1.11 vs. -0.46±1.1, P<0.05), compared to the control group of subjects. In addition, serum total alkaline phosphatase was significantly higher in patients (246.5±127 vs. 190±65.3, P=0.004), but the total calcium, parathyroid hormone and 25 hydroxy vitamin D did not differ significantly between patients and controls.
    Conclusion
    Our results suggest that maintenance therapy with antiepileptic drugs may decrease bone mass. These data also suggest a higher bone turnover rate in those receiving anticonvulsants.
  • H. Salehi, A. R. Sayadi, M. Tashakori, R. Yazdandoost, N. Soltanpoor, H. Sadeghi, M. Aghaee, Afshar Page 555
    Background
    Drug abuse and its consequences are major health problems in Middle-East countries such as Iran. Salesmen and smugglers may add lead to opium during the process of opium preparation to increase the weight of opium for more profit. Several reports have found lead poisoning symptoms in opium addicted patients and there are many nonspecific symptoms mimicking lead poisoning in opium addicted patients. As far as the literature review is concerned, there is no comparative study about blood lead level (BLL) in addicted patients with healthy controls. Therefore, it seems evaluation of blood lead level in opium addicted patients to be important.
    Methods
    In this study, the BLL of forty-four subjects in two patient and control groups was evaluated. The patient group (22 subjects) was comprised of patients who used oral opium. Control group (22 subjects) was matched with the patient group for age and sex, considering inclusion and exclusion criteria with a mean age of 38.8±6.7. For blood lead assay, 3 mL of whole blood was obtained from both groups by venipuncture and BLL was assessed immediately using an atomic absorption spectrophotometer.
    Results
    The BLL in patient group had a range of 7.2 to 69.9 mg/dL with a mean of 21.9±13.2. In the healthy control group, BLL was between 4.1 to 17.4 mg/dL with a mean of 8.6±3.5. The mean difference of both groups (t=4.56) was statistically significant (P<0.0001). In the patient group, BLL had a significant correlation with the amount of opium ingested (r=0.65, P<0.01). However, there was no significant correlation with duration of opium ingestion in the patient group.
    Conclusion
    It would be concluded that opium addicts have an elevated BLL compared to healthy controls. Therefore, screening of blood lead concentration is helpful for opium addicted people especially with non-specific symptoms. In this regard, a similar investigation with a larger sample size of opium addicted patients (including both oral and inhaled) and a control group is suggested to confirm the findings of this research.
  • M. Amin, Esmaili, S. Nedjat, A. Motevalian, A. Rahimi, Movaghar, R. Majdzadeh Page 559
    Background
    With the expansion of scientific documents worldwide and the growth of Iranian articles published in recent years, highly sensitive electronic resources containing scientific studies can be of great help to researchers at different stages of research. This study has been conducted to examine the sensitivity of domestic and international databases to locate Iranian articles related to substance abuse disorders or addiction.
    Methods
    Iranian articles in three domestic databases (Iranpsych, Iranmedex, and SID) and three international databases (PsycInfo, Embase, and Medline) were compared, separately. All articles in English or Persian related to the subject in one year period (2002) were selected by two reviewers. The log linear model was applied to estimate the total number of articles and sensitivity of each database.
    Results
    As a whole, 129 Persian articles and 29 English articles related to addiction were found in six domestic and international databases. Among domestic databases the sensitivity of each database (Iranpsych, Iranmedex, and SID) was estimated to be 66.5, 55.7 and 40.5%, respectively. Among the international databases (PsycInfo, Embase and Medline) were estimated to have 22.1, 19.1 and 17.6% coverage, respectively. A crossover search of articles retrieved from domestic databases showed that 11.6% of the Iranian articles had been published in English in international journals.
    Conclusion
    Our findings suggest that after searching at least one general and one specialized Iranian database, 80% of studies relevant to addiction in Iran can be accessed. Introduction of developing countries’ domestic databases can be beneficial in a more comprehensive access to scientific documentations.
  • A. Kalantar, Hormozi, S. Loghmani, S. Motamed Page 566
    Background
    The authors describe their experience with the retroauricular temporal flap in facial reconstruction.
    Methods
    Twenty-two (20 females, 2 males) patients with composite tissue defect of various areas of the face have been esthetically reconstructed with a modified Washio flap. This flap is a good choice for facial reconstruction, due to its color match, reliability, feasibility, and potential for modification including elements such as skin, hair, and cartilage. The donor site is inconspicuous.
    Results
    The 22 patients in this report underwent reconstruction without flap loss.
    Conclusion
    The Washio flap, with different modifications, is a useful technique for reconstruction of facial defects which may include hairy and non-hair bearing skin, preferably not larger than 7x5 cm in size, and particularly in young patients.
  • H. Vahedi, S. Momtahen, G. Olfati, A. Abtahi, S. Hosseini, A. S. Kazzazi, H. Khademi, S. Rashtak, R. Khaleghnejad, T. Tabrizian, Z. Hamidi, M. Nouraie, F. Malekzadeh, S. Merat, S. Nasseri, Moghaddam, R. Sotoudehmanesh, B. Larijani Page 570
    Background
    Osteoporosis has been frequently reported in patients with inflammatory bowel diseases, especially Crohn’s disease.
    Methods
    All consecutive Crohn’s disease patients who attended the GI Clinics at Shariati Hospital, Tehran, Iran, from 2004 to 2007 were evaluated. A BMD-DEXA assessment was performed for all patients. Among those patients diagnosed with osteoporosis (T score ≤ -2.5 SD), 30 patients were chosen as study cases. Of those who were not diagnosed with osteoporosis, 85 were chosen as the control group. A thorough patient history including: age, sex, body mass index, cumulative corticosteroid dose, previous fracture, history of bowel resection, site and duration of disease, smoking and consumption of calcium and vitamin D, was taken from all patients through a face-to-face interview. Independent sample Student’s t-test, Chi-square, and logistic regression analyses were used for data analysis.
    Results
    In this study, a multivariable modeling technique revealed a higher osteoporosis risk in those who had a lower body mass index, previous fractures and longer disease duration. A cumulative corticosteroid dose of 10 – 35 g provided the highest osteoporosis risk. Age, sex, bowel resection, site of disease, smoking and consumption of calcium and vitamin D did not show any relationship with osteoporosis.
    Conclusion
    The highest osteoporosis risk was seen in patients with a cumulative 10 – 35 g corticosteroid dose and could be due to both steroid inefficiency in reducing Crohn’s disease inflammation as well as the cumulative drug dose and it’s adverse effect on patients.
  • R. Malekzadeh, M. H. Derakhshan, Z. Malekzadeh Page 576
    Although the global incidence of gastric cancer has been decreased dramatically in recent decades, it is the most common cancer in north and northwest Iran. The wide variation in incidence across different geographical areas and higher proportion of cardia cancer are two main characteristics of gastric cancer in Iran. Current investigations indicate that a high prevalence of H.pylori infection, high dietary intake of salt and smoking are the main environmental factors of gastric cancer in Iran. Gastroesophageal reflux disease is another contributing factor in populations with a higher incidence of gastric cardia cancer. While interventions on modifiable environmental risk factors should be considered as the main modality to reduce gastric cancer development, surveillance programs for early detection of cancer in highly selected groups may increase overall survival rates in potential patients in this country.
  • M. J. Fattahi, Z. Mojtahedi, N. Karimaghaee, A. R. Talei, S. J. Banani, A. Ghaderi Page 584
    The germline mutations of breast cancer susceptibility genes 1 (BRCA1) and breast cancer susceptibility genes 1 (BRCA2) have been associated with a significant increase in breast cancer risk and certain other cancers. Among the most known mutations in these tumor suppressor genes are 5382insC and 185delAG in BRCA1 and 6174delT in BRCA2. The aim of the current study was to investigate the frequency of these BRCA1 and BRCA2 mutations in southern Iranian familial and sporadic cases with breast cancer.Two hundred fifty women with sporadic breast cancer, 55 women with a familial history of breast cancer in their first degree-relatives and 200 healthy women formed the studied groups. DNA from peripheral blood mononuclear cells was extracted and analyzed by a multiplex polymerase chain reaction method. The data of this investigation indicated that the aforementioned founder mutations were not detected in the groups studied. Our results indicate that 5382insC and 185delAG mutations in BRCA1 and 6174delT in BRCA2 have much less frequency in Iranian breast cancer patients.
  • A. Borhani Haghighi, A. Nabavizadeh, J. O. Sass, A. Safari, K. B. Lankarani Page 588
    Mitochondrial neurogastrointestinal encephalomyopathy is an autosomal recessive disorder in which a nuclear mutation of the thymidine phosphorylase gene leads to mitochondrial genomic dysfunction. Herein, we report a 29-year-old Iranian man with abdominal pain, diarrhea, hearing loss, ophthalmoplegia, sensorimotor axonal neuropathy, and elevated muscle enzymes. Magnetic resonance imaging showed leukoencephalopathic changes. Metabolite analysis revealed a very high thymidine concentration in the patient''s urine consistent with the diagnosis of mitochondrial neurogastrointestinal encephalomyopathy.
  • A. Rasi, N. Pour, Heidari Page 591
    Perianal streptococcal dermatitis is an uncommon superficial cutaneous infection of the perianal area almost exclusively described in children. Perianal streptococcal dermatitis is caused by group A beta-hemolytic streptococci and occurs mainly in children between six months and ten years of age. Prior therapy with topical antifungal agents, topical corticosteroids, and oral preparations for pinworms either fails to improve or worsens patient’s symptoms. Early antibiotic therapy causes a dramatic and rapid improvement of symptoms. Treatment protocol consists of amoxicillin 40 mg/kg/day, divided into three doses, and/or topical application of mupirocin 2% ointment three times per day for ten days. We describe a four-year-old boy with perianal streptococcal dermatitis who was brought to our clinic with plaque type psoriasis.
  • S. Shoja Shafti, Z. Nicknam, P. Fallah, L. Zamani Page 595
    Multiple sclerosis can create a variety of somatic, cognitive, and behavioral symptoms. Here we report a patient with early psychiatric symptoms including depression, dementia, and catatonia, who was eventually diagnosed as having primary progressive multiple sclerosis
  • M. Mobini, A. Javadzadeh, J. Forghanizadeh Page 599
    This report describes a 23-year-old man who presented with multiple joint deformities as a consequence of multiple painless intra-articular fractures.Blood counts, biochemistry, and nerve conduction velocity were all normal. X-ray studies showed joint destruction in hips, elbows and knees.We concluded that he is a case of congenital insensitivity to pain culminating in multiple charcot joints.
  • Z. Mirfeizi, M. Pezeshki Rad, S. Hashemzadeh Page 603
  • F. Davatchi Page 605
    Rheumatology program at Tehran University was established by Fereydoun Davatchi in 1969. Later, Reza Moghtader, Firouz Panahi, and Amir-Khan Chafizadeh joined him. The first rheumatology outpatient clinic was founded in 1970. In 1974, the first rheumatology fellowship department was established along with a small research laboratory. The department expanded gradually to become the Rheumatology Research Center (RRC) in 1981. RRC was officially recognized in 1994 by the Ministry of Health and in 2001 as the Center of Excellence for Rheumatology in Iran. There are 15 rheumatologists who are the teaching staff at RRC. The center has trained up to 45 rheumatologists since 1985. RRC has conducted about 150 research projects (national and international collaborative projects). It has published 14 yearly books and collaborated in the publication of seven international books. RRC has presented 207 papers in local and 337 papers in international conferences. RRC has published 50 papers in local and 178 papers in international journals.
  • K. Vessal, S. Rad, A. Alizadeh, J. Jalal, Shokouhi Page 611
    Historically, stratification in medical profession has followed certain patterns pertinent to the nature of the work and the organ of interest. Evolution of radiology was, however, different insofar as it followed an accidental discovery toward the end of the 19th century. The physical properties of the discovered rays were to set the initial direction for future expansion of the discipline.
  • Page 619