Archives of Iranian Medicine
Volume:17 Issue: 9, Sep 2014

Osteoprotegerin (OPG), a key factor in bone remodeling and vascular calcification, has been suggested to be associated with cardiovascular events. This study sought to assess the relationship between plasma OPG, anthropometric, metabolic status, severity and extent of coronary artery calcification, and the two-year recurrence risk of coronary event in patients with coronary heart disease (CHD). A total of 155 consecutive patients with symptoms suggestive of CHD were enrolled in this cross-sectional study. Blood samples were taken for laboratory tests. Coronary angiography and cardiac CT scan were performed to assess the severity and extent of involved vessels. Two-year risk of subsequent CHD was estimated based on the computational Framingham risk prediction model. OPG level was in direct linear association with age (β = 0.38, p < 0.001), waist to hip ratio (β = 0.17, p < 0.05), hs-CRP (β = 0.17, p < 0.05), systolic and diastolic blood pressure (β = 0.17, p < 0.05; β = 0.23, p < 0.01), and HbA1c (β = 0.17, p < 0.05). After age-sex adjustment, only HbA1c (β = 0.15, p < 0.05) was a significant indicator of serum OPG. OPG showed significant linear association with the coronary calcium score (CCS), and the number of involved vessels even after adjustment for age, sex, diabetes, blood pressure, and markers of bone-calcium metabolism (β = 0.27, P < 0.05; β = 29, P < 0.01). There is a significant positive association between two-year risk of subsequent CHD and serum OPG in females (β = 0.45, P < 0.01) but not in males. Increased OPG is independently associated with the severity and extent of CHD. This study also proposes OPG as a potential marker in predicting the risk of subsequent CHD, in females.

We assessed the performance of single fiber reflectance spectroscopy (SFRS) in discriminating cervical squamous intraepithelial lesions (SIL) from non-SILs and the probable influence of environmental factors on its performance. SFRS was used to measure the reflected light from cervical tissue of 157 patients undergoing standard colposcopy. Seven parameters extracted from the spectra in addition to two biographic parameters were used to compare the biopsy-confirmed SILs with non-SILs. The tissue classification capability was reported by receiver operating characteristic (ROC) curves. In addition, the effect of five interfering parameters, including the probe, clinician, hospital, menopausal status and age of the patient on spectroscopic parameters were investigated by the Kruskal-wallis test. The average vessel diameter and beta-carotene concentration were found to be the parameters contributing to tissue discrimination. SFRS could differentiate between SILs and non-SILs with sensitivity, specificity and area under the ROC curve of 63% ± 6%, 68% ± 6% and 0.69 ± 0.04, respectively. None of the five environmental parameters interfered with the discriminator spectroscopic parameters. SFRS was found as a noninvasive, fast, compact, cost-effective, independent, and acceptably accurate system to help the clinician to reduce the number of unnecessary biopsies during the colposcopy procedure.

Obesity is associated with chronic disorders like coronary artery diseases, metabolic syndrome, cancers, and psychiatric disorders. Stress may contribute to weight gain by disrupting weight concern, and lead to uncontrolled eating behavior. This study aimed to investigate the effects of stress on weight concern and control behaviors in normal weight and obese adults. A total of 9544 subjects were selected by multi-stage random sampling from three provinces in central Iran. Information related to weight concern and control behavior was registered in normal weight and obese participants. Psychological distress was measured by a 12-item General Health Questionnaire (GHQ-12) and subjects were divided into high and low stress groups. Logistic regression was used for analysis. The mean age of participants was 38.7 ± 15.5 years and 50% (4772) of them were males. The adjusted odds ratio (OR) for age, sex and education of high stress to low stress level for weight concern, weight control behavior and acceptable physical activity behavior was more than 1; but the OR was less than 1 for waist circumference, obesity and healthy diet behavior. Among obese participants, higher levels of stress were associated with lower weight concern with OR, 95%CI: 0.821, (0.682 – 0.988), lower acceptable physical activity with OR = 0.833, 95%CI: (0.624 – 0.912), but higher rates of healthy diet behavior with OR = 1.360, 95% CI: (1.040 – 1.780). Individuals with high stress level have lower weight concern and lower physical activity; therefore, they are prone to weight gain and obesity. It could be concluded that stress management should be considered as a crucial component of obesity prevention and control programs.

Evaluating trends in blood donors’ infectious diseases is essential for monitoring the safe supply of blood, donor screening effectiveness, and the occurrence of infections in the blood donor population which consequently gives an idea of the epidemiology of these diseases in the community. The aim of the present study was to assess the prevalence of hepatitis B, hepatitis C, HIV and syphilis by carrying out confirmatory tests in Tehran’s blood transfusion center between 2005 and 2011. This was a retrospective study conducted at Tehran’s Blood Transfusion Center (TBTC) from 2005 to 2011. All donor serum samples were screened for HBV, HCV, HIV and syphilis using third generation ELISA kits and RPR test. Initial reactive samples were tested in duplicate. Confirmatory tests were performed on all repeatedly reactive donations. For statistical analysis, T- test, ANOVA and Chi-square test were carried out on SPSS software and 95% confidential intervals (95% CI) were used. Over a period of six years (March 2005 to March 2011), a total of 2,026,628 donations were collected. Out of the total blood donors, 10,476 were positive for HBV, HCV, HIV and syphilis. The overall frequency of HBS Ag, anti-HCV, HIV Ag/Ab and syphilis antibodies were 388,112, 5.4 and 10.5 per 100,000 donations, respectively. The prevalence of HBV among blood donors showed a downward trend over the period of six years. The trend of HCV fluctuated during the period under study, peaking in 2007. The trend of HIV infection frequency had increasing patterns in 2011. The trend of syphilis infection frequency was increasing in 2008 and decreasing after that. Declining trend in prevalence of blood-borne infections indicates the effectiveness of screening methods and selection of appropriate donors. Higher prevalence of blood-borne infections in males, low educated, married, first-time donors and donors who referred to the mobile centers requires a different planning in these groups.

BACKGROND: Following MPOWER’s 2011 report, a study was conducted to quantify the implementation of MPOWER tobacco control policies in the Eastern Mediterranean Region (EMR) in 2013 to assess any possible change during the last two years. In this cross sectional study, based on 10 categories mentioned in MPOWER 2013, a checklist was designed and its scoring was agreed upon by Iranian and international tobacco control specialists. Seven questions were scored from 0 – 4 and 3 from 0 – 3. The 22 countries were ranked by their total score on a scale of 0 to 37. Among the 22 countries in the EMR, Iran, Kuwait, Egypt, Lebanon, Gaza & West bank and Jordan were scored 31, 28, 28, 26, 25 and 25 respectively. 14 countries scored more than 50%, a small improvement; 5 countries have seen their scores fall, and three countries received the same score as last time. The highest overall improvement was attributed to the warning label, and the sharpest decline was observed in the consumption category. There has been a slight overall improvement in tobacco control planning, although the desired levels have yet to be reached and some countries in the region have fared worse. Archives of Iranian Medicine,Vol. 17, No. 09, September 2014, - Keywords:

Pemphigus is an autoimmune blistering mucocutaneous disorder. Common treatments include corticosteroids and immunosuppressive drugs. This study aimed to assess the therapeutic effects of oral prednisolone along with the common adjuvant therapy in pemphigus vulgaris. Eighty-seven patients with pemphigus vulgaris from the first stage of a previously randomized clinical trial were enrolled in the present non-blinded clinical trial. The patients were divided into four groups and treated accordingly with prednisolone alone (P; N = 23), prednisolone and azathioprine (P/A; N = 23), prednisolone and mycophenolate mofetil (P/M; N = 21), and prednisolone and cyclophosphamide (P/C; N = 20). These patients were followed-up for an extended one-year period. The primary localization of the recurrence occurred in the oral cavity of 7, 6, 2, and 5 patients in the P, P/A, P/M, and P/C groups, respectively. There was no significant difference between them (P = 0.40). The mean total dose of prednisolone administered in groups P, P/A, P/M, and P/C was accordingly 7.5, 8.4, 9.2, and 8.6 mg/day. Minor recurrence of the disease in the above-mentioned groups was observed in 7 (30.4%), 5 (21.7%), 6 (28.6%), and 7 (35.0%) of the patients, respectively. With regard to the minor recurrence of the disease, there was no significant difference among the four treatment groups (P = 0.80). Since in this follow-up study no therapeutic benefit of oral prednisolone and common adjuvant therapy was found in terms of the number of minor and major recurrences, the extent to which treatment of PV can be improved upon treatment with these agents remains to be elucidated.

Glutaric Aciduria type 1 (GA1) is a metabolic inborn error and is characterized by increasing excursion of glutaric acid and its derivates, presented in microcephaly and dystonia. The disease is resulted from mutational inactivation in the GCDH gene encoding the glutaryl-CoA dehydrogenase. The defective enzyme causes the accumulation of an excessive level of intermediate breakdown products that leads to the brain damage. In spite of the clinical features, diagnosis of GAI has been often confusing, because of variability in the clinical manifestations of patients. Early diagnosis and treatment can though prevent irreversible disease progression and consequent brain damage; otherwise the affected individuals will die in their first decade of lives. The GCDH gene was also analyzed to (detect or identify) disease causing mutations using gene amplification and direct sequencing in 18 patients. Among 18 patients, 10 patients (55.5%) were homozygous or compounded heterozygous for the recurrent mutation E181Q, three patients (16.7%) were homozygous for the known mutation R402Q and one patient (5.6%) was compound heterozygous for S255L. All three detected missense mutations are pathogenic, which cause structural changes in the binding site and tetramerization or functional deficiency. Four other individuals (22.2%) with a preliminary diagnosis of GAI were negative for any pathogenic mutations. Most GA1 affected persons in southwest Iran are with Persian ethnicity and the most common mutation in Khuzestan Province is prominent in comparison to previous reports from Iran.

Elevated heart rate (HR) is known to be a risk factor. The aim of the present study was to investigate the association of HR with the incidence of cardiovascular disease (CVD) in Iranian adults. The Isfahan cohort study (ICS) was a longitudinal study started in 2001 on 6504 adults aged ≥ 35 years in urban and rural areas of central Iran. In a nested case control study, a control was randomly selected for each CVD event occurring during 7 years of follow up using density sampling method. HR at baseline was assessed by electrocardiogram. CVD was defined as incident coronary heart disease (myocardial infarction, unstable angina and sudden cardiac death) and stroke. The odds ratios (OR) were estimated by conditional logistic regression. 432 participants with CVD events in the case group and 401 participants free of CVD in the control group were included in the analysis. While HR did not show any significant relationship with CVD events in the crude model (P = 0.208), it was detrimentally associated with them when age was included (OR = 1.01, 95% CI: 1.00 – 1.02, P = 0.024). A dose response effect of quintiles of HR was seen in which significant association with CVD events started at third quintile [OR = 1.98 (1.15 – 3.41)] and increased toward fifth quintile [OR = 2.53 (1.47 – 4.36)] in the adjusted model for age, sex and HR-lowering drugs (P for trend = 0.001). This association remained statistically significant when other traditional risk factors were included in the model. An elevated heart rate was associated with the occurrence of cardiovascular events. It can be considered as a predictor of cardiovascular disease independently of other risk factors in Iranian adults.

Gastrointestinal lymphoma is the most common type of extranodal non-Hogkin’s lymphoma. The proportion and different types of primary extranodal gastrointestinal non-Hodgkin’s lymphoma are different in various geographic locations. Therefore, in this study we tried to evaluate the various types of extranodal gastrointestinal non-Hodgkin’s lymphoma in affiliated hospitals of the Shiraz University of Medical Sciences as the largest referral center in the southern Iran. DESIGN: During 5 years (2005 – 2010), the pathology archives and clinical charts of all patients diagnosed with primary gastrointestinal non-Hodgkin’s lymphoma in the affiliated hospitals of the Shiraz University of Medical Sciences were evaluated. All demographic and pathologic findings were recorded. During these 5 years, there were 110 cases with the diagnosis of primary gastrointestinal lymphoma. The most common location was stomach followed by small intestine and colon. The most common type was diffuse large B cell type. There were only two cases of immunoproliferative small intestinal lymphoma. The pattern of gastrointestinal lymphoma in Iran is very similar to the Western countries. Compared with 40 years ago, it seems that the epidemiology of this lymphoma has changed.

Liver transplant can be challenging in cirrhotic patients with diabetes mellitus. In chronic liver disease, the glucose metabolism is altered; uncontrolled diabetes negatively influences the outcome of liver transplantation and poses difficulty in the management of immediate post transplantation period. Simultaneous liver-pancreas transplantation is an option to prevent early complications due to diabetes and also to improve the quality of life after transplantation in patients with Insulin-Dependent Diabetes Mellitus (IDDM) and chronic liver disease. We report the first en-bloc liver-pancreas transplant done in the transplant history of Iran. We describe the technical details of the procedure as well as the short term outcome after transplantation. In this case report, we also discuss in some details, the surgical, medical and immunological advantages of combined liver–pancreas transplantation as opposed to separate implantation of both organs.

Wolf-Hirschhorn syndrome (WHS) is a disorder that affects many parts of the body. The major features of this condition include specific craniofacial malformations, delayed growth and development, intellectual disability and seizures. Here, we report a case of WHS: a 27-month-old girl with a microdeletion at distal part of short arm of chromosome 4. She had striking clinical features of WHS and had an apparently normal karyotype. Array comparative genomic hybridization performed on the DNA extracted from peripheral blood revealed loss of 1.7Mb at 4q16.3-q15.3. Taken together, this data suggests that a patient with strong clinical suspicion of chromosome abnormality and normal conventional karyotype analysis should be further evaluated by molecular cytogenetic techniques such as array comparative genomic hybridization (aCGH) or fluorescence in situ hybridization (FISH).

Ovary juvenile granulosa cell tumors (JGCT) are rare sex cord-stromal tumors that are most commonly encountered in prepubertal girls. These tumors can be of the adult type (95%) and juvenile type (5%). The main causes of complaint are abdominal distention and abdominal pain. Definitive diagnosis is confirmed by histopathologal and immunohistochemical examinations. A 10-year old girl presented with massive abdominal distention, acute abdomen findings and ascites. Abdominopelvic magnetic resonance imaging showed masses with multiple cysts and solid components in the left ovary. Tumor markers were normal, but serum estradiol level was elevated. The patient underwent mass resection with left salpingo-oophorectomy and total omentectomy. Final histopathological diagnosis was JGCT. We herein reporte an extremely rare case of advanced stage JGCT causing massive ascites and acute abdomen.