Archives of Iranian Medicine
Volume:14 Issue: 3, May 2011

WHO reports indicate no iodine insufficiency in Iran, however, goiter is still endemic in Fars Province. This study evaluates the role of thyroid autoimmunity in the evolution of endemic goiter. A total of 516 permanent residents of Akbarabad County of the Kavar area in Fars Province, Iran were selected by simple random sampling. Patients with thyroid malignancy and dysfunction, and those who consumed drugs affecting thyroid function were excluded. After signing a written consent form and undergoing a thyroid examination, 5 cc of blood were drawn to measure free T3 and T4 (RIA), TSH (IRMA), and anti-thyroid peroxidase (competitive RIA) levels. Moreover, samples of 50 cc morning urine were collected for the measurement of urinary iodine excretion (UIE; chloridric acid digestion). Data were analyzed by SPSS (version 13). P<0.05 was significant. The prevalence of goiter was 38.4% by WHO classification. The prevalence of children with UIE 2 – 4.9 µg/dL was 5.8%, which indicated sufficient iodine intake. Goiter was more prevalent in females, as well as in patients with positive anti-TPO or higher TSH titers (P<0.01). The prevalence of positive anti-TPO was higher in goiterous patients than healthy persons (P=0.002), which increased with an increase in age, grade of thyromegaly or TSH (P<0.02). Regression analysis showed the odds ratio for diagnosing goiter in females was 2.4 (P<0.001), in those with positive anti-TPO it was 1.87 (P=0.03) and in those with TSH>5.2 mIU/mL the odds ratio was 2.74 (P=0.01). In adolescents compared to children the odds ratio was 0.36 (P=0.01) and the odds ratio in adults to children was 0.33 (P=0.001). This study indicates that despite normal UIE, goiter is endemic in Akbarabad County. Some degree of goiter endemicity may be due to thyroid autoimmunity.

Although standard first line treatment of acute promyelocytic leukemia is All trans retinoic acid (ATRA) and chemotherapy, some patients relapse and need a second line of treatment. Relapsed cases of promyelocytic leukemia can be salvaged with arsenic trioxide. Between May 1999 and Jan. 2010, we treated 31 relapsed cases of promyelocytic leukemia with arsenic trioxide. These cases relapsed after previous treatment with ATRA and chemotherapy. We applied arsenic trioxide as 0.15 mg/kg iv infusion until complete remission. After achieving complete remission patients received 2-4 consolidation therapy in the same schedule as remission induction. The median age of patients was 27 years. Complete remission rate was 77.4%. We observed four mortalities during remission induction. With a median follow up of 32 months, ten more relapses occurred. Two year disease-free survival and overall survival for the entire cohort was 54.6% and 81.1%, respectively. Our result is the same as other studies. Thus, we suggest that arsenic trioxide can be used as salvage therapy in patients who relapsed. Despite a good complete remission rate, the relapse rate during the first two years of treatment is high and hematopoietic stem cell transplantation should be considered after achieving complete remission.

The possible prognostic significance of the expression of a variety of markers has been investigated in acute lymphoblastic leukemia (ALL). In the present study we investigated the prognostic significance of CD13 and CD33 myeloid antigens (MY) aberrantly expressed on the blasts of ALL patients and Bcl-2 anti- apoptotic molecule expression in childhood ALL. Aberrant expression of MY occurred in 8.8% of cases. Variant levels of Bcl-2 were expressed in patients (44.2±25.5%), with more than 20% positivity for Bcl-2 in 64.7% of patients. Bcl-2+ patients survived 959±242 days compared to 1059+230 days for Bcl-2- patients (P=0.2). Corresponding data for complete remission duration was 682±170 and 716±173 days (P=0.3), respectively, indicating no significant association between survival and complete remission duration of patients with expression of the Bcl-2 molecule. Analysis of clinical response according to MY expression, however, showed significant association with survival and complete remission duration. MY+ patients had shorter complete remission duration (383±58 days) and survival (473±68 days) than MY- patients (complete remission duration, 724±144 days; survival, 1045±186 days; P<0.001). Expression of Bcl-2 along with MY was not associated with a significant decrease in survival or complete remission duration Results of this study indicated that expression of MY was a poor prognostic factor in childhood ALL. Bcl-2 expression in MY+ patients could not influence the response to therapy.

About 50,000 new cancer cases occur annually in Iran, of which gastrointestinal (GI) cancers are the most common. Colorectal cancers (CRC) account for the third and fourth most prevalent cancers amongst Iranian men and women, respectively. Since CRC has some well-known hereditary forms with differences in their prevalence according to regional heterogeneity, we designed a study to assess familial aspects of this cancer in subjects who reside in Mazandaran Province, Iran. We interviewed all CRC patients who attended a private GI clinic during 1999 – 2007, with histologically confirmed diagnoses of colorectal adenocarcinoma, about their family histories of CRC and age at diagnosis. Pedigrees were drawn up to second-degree relatives. A total of 293 CRC cases enrolled in the study, of which 152 were male and 141 were female. The mean age of patients was 52.6±15.2 years. Of these, 98 patients (33.5%) were under the age of 45. A total of 66 cases (22.5%) had familial histories of CRC, being significantly more prevalent in younger subjects (11.2% vs. 44.9%, P<0.0001). Thirty-two patients (10.9%) fulfilled the criteria for hereditary non-polyposis colon cancer. In addition, right-sided colon cancers were more prevalent in those with positive familial histories (P<0.05). Due to the frequency of early-onset CRC and familial syndromes, a more intense screening protocol for early detection of CRC should be developed for this population

One possible reason for being controversies regarding ADHD may be related to the validity and reliability of diagnostic criteria of attention deficit hyperactivity disorder and oppositional defiant disorder. Diagnostic criteria of oppositional defiant disorder include eight symptoms. This study examines the factor structure of oppositional defiant disorder symptoms, its discriminant validity from attention deficit hyperactivity disorder, its convergent validity and internal reliability. Parents of 111 referral children and adolescents with attention deficit hyperactivity disorder completed DSM-IV referenced based attention deficit hyperactivity disorder and oppositional defiant disorder checklists. Factor analysis indicated that the attention deficit hyperactivity disorder symptom of: “often has trouble organizing activities” and “often runs about or climbs when and where it is not appropriate” were a part of the oppositional defiant disorder component. These symptoms less often than other symptoms differentiate attention deficit hyperactivity disorder from oppositional defiant disorder. The convergent validity for oppositional defiant disorder symptoms ranged from 0.64 to 0.79. The parent-rating checklist of oppositional defiant disorder symptoms properly differentiates oppositional defiant disorder from attention deficit hyperactivity disorder. However, two items of the attention deficit hyperactivity disorder were listed as symptoms of oppositional defiant disorder. If the factor loading of the items is to be confirmed in further studies, it might be necessary to revise these symptoms criterion in future editions of DSM-IV diagnostic criteria.

This was an analytical historical cohort study based on an existing data base study conducted in different areas of Tehran. The present study determined the effect of demographic factors and cigarette smoking status on success rate of addiction treatment in outpatient treatment and rehabilitation clinics for substance abusers. We accomplished our study in outpatient clinics authorized by the “welfare organization,” which included three governmental treatment centers and private centers among those located in 22 regions of Tehran. Data were collected using a checklist, which contained demographic characteristics, personal information and information about prevention, treatment and follow-up records of 1372 patients. Factors associated with addiction treatment success rate were reviewed using multiple logistic regression tests Our study showed that addiction treatment was successful in only 258 cases (18.8%). The final multiple regression model showed that single and married patients were 2.18 times (P=0.033) and 2.70 times more successful in quitting than divorced, or separated cases (P=0.005). In addition, patients who lived in rental or mortgaged houses were 1.43 times more successful than homeowners (P=0.036). More than 90% of participants in this study were daily smokers at the time of the study. Patients who did not have a history of smoking were 1.69 times more successful than ex-smokers (P=0.007). Based on our study results only a few people were successful in addiction treatment; marital status, type of housing, residential status and smoking status were the most important factors associated with the outcome of addiction treatment.

Autosomal recessive spinal muscular atrophy is a disease resulting from homozygous absence of SMN1 gene in approximately 94% of SMA patients. To identify patients who retained a single SMN1 copy, SMN1 dosage analysis was performed by quantitative Real-time PCR using SYBR green dye. SMN1 dosage analysis results were utilized to identify carriers before offering prenatal diagnosis. Carrier testing was performed for 150 individuals. Copy number of the SMN1 gene was determined by the comparative threshold cycle (Ct) method and human serum albumin gene was used as a reference. Analysis of 150 DNA samples with quantitative PCR determined the number of SMN1 gene copies. Of these, 50 (33.33%) cases had one SMN1 gene copy, 87 (58%) had two copies and 13 (8.66%) did not have any copies of SMN1. The homozygous SMN1 deletion ratio was 0.00 and deletion of one copy of SMN1 gene ratio ranged from 0.3 to 0.58. This report demonstrates modification of risk estimation for the diagnosis and detection of SMA carriers by accurate determination of SMN1 copy number. SMN1 copy number analysis is an important parameter for identification of couples at risk of having children affected with SMA. It also reduces unwarranted prenatal diagnosis for SMA. Furthermore, the dosage analysis might be useful for the counseling of clinically suspected SMA patients with negative diagnostic SMA tests.

H. pylori is now a known cause of gastric and duodenal ulcers, noncardia gastric cancer and gastric MALT lymphoma. In addition, the role of this microorganism in causing or preventing a large number of other diseases has been investigated, some of which include esophageal cancer, functional dyspepsia, gastroesophageal reflux disease, asthma, cardiovascular diseases, iron deficiency anemia and idiopathic thrombotic purpura. This article reviews the evidence for these associations and provides suggestions for further research.

The Fas/Fas ligand (FasL) system has been recognized as an important pathway for apoptosis induction in cells and tissues. It has recently been shown that skin lesions of pemphigus vulgaris are associated with Fas mediated apoptosis. The aim of this study was to evaluate the level of serum soluble Fas of ten newly diagnosed patients with pemphigus vulgaris. Sera were collected from ten patients with pemphigus vulgaris. Commercial sandwich enzyme-linked immunosorbent assay (ELISA) for quantitative detection of soluble Fas was applied. Patients with mucosal skin involvement had higher median values in contrast to patients with cutaneous involvement. Elevation of soluble Fas in our study may give insights for the pathogenesis of pemphigus vulgaris. Suppression of this underlying mechanism may be an important target for novel therapies and relapse prevention.

Institutional Review Boards (IRBs) have been designed to ensure that ethical considerations are in research projects. Although their role is vital in order to protect the rights of research participants, there are still unmet needs in improving the function and structure of IRBs. These aspects include but are not limited to inconsistency, conflict of interests, unequal sexual distribution, efficacy of non-scientific members, high expenses, unequal regional distribution, high work load, approach to reach a final decision, and the definition of minimal risk research.

Neuropsychiatric side effects of peg interferon- (PEG-IFN-) therapy consist of a large spectrum of symptoms. Organic personality syndrome, organic affective syndrome, psychotic manifestations and seizures are more common side effects of PEG-IFN- whereas cranial neuropathy and movement disorders are less common. Bell’s palsy is often idiopathic, but has been linked to some viral infections, particularly with herpes viruses. Other infections, such as human immunodeficiency virus infection and Lyme disease, may also lead to idiopathic facial paralysis. Neither acute nor chronic Hepatitis C infection has been implicated previously in Bell’s palsy, but PEG-IFN- may play a role. Two patients with CHC who developed Bell’s palsy before and during treatment with PEG-IFN- and Ribavirin are presented here.

Neuromyotonia with all its synonyms is a disorder of peripheral nerve hyperexcitability characterized by regular or irregular myokymia, muscle cramps and stiffness, delayed muscle relaxation after contraction, and hyperhidrosis associated with well-described spontaneous electromyographic features. Herein, we report clinical and electrodiagnostic findings of a pregnant woman with neuromyotonia who also suffered from chronic inflammatory demyelinating polyneuropathy. We treated the patient with plasma exchange, 50 mL/kg (twice weekly, for six weeks). After two weeks of treatment, cramps and stiffness were substantially reduced. After four weeks, she looked normal with a relatively smooth gait. After eight weeks, the patient was entirely well with no cramps or stiffness. Repeat EMG showed no myokymic discharges. After four months she was in good health and the plasma exchanges continued every other week without the use of corticosteroids or cytotoxic agents. Afterwards, we discontinued the plasma exchange and only visited the patient regularly. One year later, we repeated a five-day course of plasma exchange to overcome mild recurrence of myokymia in her thighs. Now, after four years, she is healthy without any disability or problem. The patient’s child has been healthy throughout without any evidence of neuromyotonia.

The history of tuberculosis as a worldwide fatal illness traces back to antiquity, a well-known disease in ancient civilizations. However, its causative agent remained unidentified until the last decades of the 19th century, when discovered by Robert Koch. In due course, preparation of the BCG vaccine, application of the Mantoux intradermal diagnostic tuberculosis test and administration of proper antituberculosis medications eventually controlled tuberculosis. However, despite these significant advancements tuberculosis remained uneradicated, particularly in developing countries after the emergence of both multidrug-resistant tuberculosis and HIV co-infection. Presented here, is a brief review of the history of tuberculosis in the world as well as its historical background in Iran, mainly during the 19th and 20th centuries.