Archives of Iranian Medicine
Volume:18 Issue: 2, Feb 2015

IMPORTANCE: No national information is available on the epidemiology of psychiatric disorders in Iran for the last decade. To estimate the 12-month prevalence of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) psychiatric disorders in Iranian population, and to investigate the severity and correlates of psychiatric disorders. Design, setting and participants: The Iranian Mental Health Survey (IranMHS) was a nationally representative face-to-face household survey with a multistage, cluster sampling design that was carried out in 2011. A total of 7886 community dwelling residents aged 15–64 were recruited.Main outcome measures: 12-month diagnoses of DSM-IV psychiatric disorders including mood, anxiety, and substance use disorders were assessed using a validated Persian translation of the Composite International Diagnostic Interview (CIDI; version 2.1). The Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I) was administered by a psychiatrist on subjects screened positive for the presence of a psychotic disorder. The severity of psychiatric disorders was determined using criteria that included markers for disability, particular diagnoses and suicide attempts. The response rate was 86.2%. The 12-month weighted prevalence of “any psychiatric disorder” was 23.6% [95% confidence interval (CI): 22.4–24.8] with 26.5% of women and 20.8% of men having one or more psychiatric disorders. The most common category of psychiatric disorders was any anxiety disorder (15.6%) and the most prevalent particular disorder was major depressive disorder (12.7%), followed by generalized anxiety disorder (5.2%) and obsessive-compulsive disorder (5.1%). A 12-month psychotic disorder was observed in 0.5% of the population (95% CI: 0.33–0.66). Almost two-thirds (63.8%) of individuals with a mental disorder had moderate or serious illness. Unemployment, being widowed/divorced and urban living were associated with a greater likelihood of 12-month disorders; while, higher socioeconomic status and having a university degree were associated with a lower likelihood. The high prevalence of psychiatric disorders, particularly major depression, merits further attention in the country’s mental health policy and program planning.

Gastroesophageal reflux disease is one of the most common disorders of the gastrointestinal tract. The prevalence of this disease ranges from 5% to 20% in Asia, Europe, and North America. The aim of this study was to estimate the burden of gastroesophageal reflux disease in Iran. Burden of gastroesophageal reflux disease in Iran was estimated for one year from 21 March 2006 to 20 March 2007. The definition was adjusted with ICD-code of K21. Incident-based disability-adjusted life year (DALY) was used as the unit of analysis to quantify disease burden. A simplified disease model and DisMod II software were used for modeling. The annual incidence for total population of males and females in Iran was estimated 17.72 and 28.06 per 1000, respectively. The average duration of gastroesophageal reflux disease as a chronic condition was estimated around 10 years in both sexes. Total DALYs for an average of 59 symptomatic days per year was estimated 153,554.3 (60,330.8 for males and 93,223.5 for females). The results of this study showed that reflux imposes high burden and high financial costs on the Iranian population. The burden of this disease in Iran is more similar to that of European countries rather than Asian countries. It is recommended to consider the disease as a public health problem and make decisions and public health plans to reduce the burden and financial costs of the disease in Ira.n

Acute ischemic stroke is a stressful condition where there is marked increase in the production of cortisol. In the past, adrenal insufficiency in critically ill patients had been shown to be associated with significant morbidity and mortality. To date, there have been no studies performed to determine its prevalence among patients with acute ischemic stroke. The aim of this study was to determine the prevalence of relative adrenal insufficiency in acute ischemic stroke by utilizing low dose (LD) and standard dose (SD) synacthen tests and to correlate it with inpatient hospital morbidity and mortality. Fifty-eight patients who fulfilled the diagnosis of acute ischemic stroke within 72 hours from the onset of a stroke were subjected to LD (1µg) synacthen test (LDST) and two hours later to SD (250 µg) synacthen test (SDST). Based on an increment of less than 250 nmol/L after LDST, 38 (65.5%) patients had relative adrenal insufficiency. However, using similar criteria with the SDST, only 18 (31.0%) patients had relative adrenal insufficiency. Three patients died during the study period and they had a tendency to have high baseline cortisol levels. The diagnosis of relative adrenal insufficiency in general was not associated with any other significant clinical outcomes. This is the first study demonstrating the prevalence of relative adrenal insufficiency amongst acute ischemic stroke patients. Utilizing the LDST, relative adrenal insufficiency was found more sensitive in detecting relative adrenal insufficiency in patients with acute ischemic stroke as compared to SDST.

Previous research has demonstrated diabetic-induced axonal transport deficits. However, the mechanism of axonal transport impairment induced by diabetes is poorly understood. Kinesin motor proteins have been shown to transport various cargos along highly polarized neurons. In the present study, we investigated the effect of regular treadmill exercise on KIF5B and Sunday Driver (SYD) mRNA levels in sensory and motor parts of spinal cord and KIF5B content in sciatic nerves of streptozotocin (STZ)-induced diabetic rats. Forty male Wistar rats were divided into four groups: (1) diabetic trained (DT: n = 10); (2) Non-trained diabetic (NTD: n = 10); (3) normal control (NC: n = 10), and (4) normal trained (NT: n = 10). Two weeks after STZ injection (45 mg/kg, i.p.), the rats were subjected to treadmill exercise for 5 days a week over 6 weeks. We determined mRNA levels and protein content by Real time- PCR and ELISA. Exercise training decreased blood glucose levels in the DT rats. Diabetes increased the KIF5B and SYD mRNA in both sensory and motor parts and KIF5B content in sciatic nerves in the NTD. Moreover, exercise training modulated the KIF5B and SYD mRNA and KIF5B content to normal levels in the DT. Exercise training in NT rats increased KIF5B and SYD mRNA in sensory and motor parts and KIF5B content in sciatic nerves. Our results suggest that diabetes seems to change spinal cord KIF5B and SYD mRNA and sciatic nerves KIF5B content and exercise training modifies it, which may be attributable to the training-induced decreased hyperglycemia.

Pseudomonas aeruginosa is one of the most common nosocomial pathogens with high mortality rates. Organisms such as Pseudomonas aeruginosa have the ability to develop high level MDR (Multi drug resistance). The MexAB-OprM system is one of the largest multi-drug resistant efflux pumps with high levels of expression and the first finding of the RND (Resistance-nodulation-division) family in P. aeruginosa. For better understanding of the antibiotic resistance mechanism in P. aeruginosa, this study was conducted to determine the expression of the genes encoding these efflux pumps in 100 strains of P. aeruginosa isolated from patients admitted to various hospitals in Hamadan using quantitative Real-Time PCR (qRT-PCR). This study examined 100 strains of P. aeruginosa isolated from patients admitted to various hospitals in Hamadan. Then, 31 samples were selected based on collected specimen type and their antibiotic susceptibility pattern; i.e., the samples with reduced susceptibility to antibiotics, particularly carbapenems. Antibiotic disk diffusion method was performed for aminoglycoside, quinolone and carbapenem. Furthermore, MIC method was performed for ciprofloxacin, gentamicin and imipenem. Finally, qRT-PCR was used for determining the efflux pump genes expression. Among eight selected antibiotics, the greatest resistance was to levofloxacin (61.2%, n = 19) and the lowest one to imipenem (9.6%, n = 3). All isolates (100%, n = 31) exhibited efflux pump MexAB-OprM genes but different expression was observed in different strains. The result of gene expression indicated that significant differences in expression of MexR (P value = 0.003), OprD (P value < 0.001), and MexB (P value = 0.026) genes. In addition, there was high level of MexR gene expression in bacteria that leads to reduced expression of MexA, MexB, and OprM. The OprD gene was presented in all strains but different expression has been observed. Identifying the bacterial resistance mechanisms is very complicated. Although efflux pump MexAB-OprM plays an important role in antibiotic resistance in P. aeruginosa, because of acting the efflux pumps on antibiotics in a non-specific manner, it is elusive to consider or describe an antibiotic resistance based on the presence or absence of an efflux pump.

Curettage and bone grafting is a method which can eliminate benign bone tumors while restoring structural integrity, reducing the risk of pathological fractures. The aim of this research is to study the clinical outcomes of using allografts and autografts, in treating benign bone neoplasms. A Historical Cohort was conducted on 119 patients with benign bone tumors treated with curettage and grafting from 2005 to 2011 in Shafa Yahyaiyan Hospital. The variables were age, gender, tumor type and location, staging, graft type, bone incorporation and recurrence. Data was analyzed with SPSS software, using descriptive statistics, tables, Fisher exact and LogRank tests. The significance level was chosen to be less than 0.05. The study was approved in Iran University of Medical Sciences. One hundred and nineteen patients, consisting of 63 treated with an allograft and 56 treated with an autograft were studied with a mean follow up of 37.5 months. 96.6% of the patients had complete incorporation of the graft into host bone after 6 months of surgery. There was no significant relationship between graft type and bone incorporation (P = 0.121). The estimated median time of recurrence was 20 months (SE= 6.55) in the allograft group and 9 months (SE= 0.77) in the autograft group using survival analysis. Using LogRank test, there was no significant difference between the median in the two methods (P = 0.288). Autografts and allografts seem to yield similar success rates in the treatment of benign bone tumors. Although more detailed researches with higher sample sizes are recommended for future studies.

Platelet concentrates (PC) are used in thrombocytopenia and inherited or acquired platelet dysfunction disorders. Thus, retaining the platelets quality and function during storage will lead to desirable outcomes in treatment of such patients.

In this study, we evaluated 40 PC bags, prepared by PRP method in IBTO centers. We applied an array of assays, on first, third and fifth days of storage for PC quality control, including swirling, cell counting, bacterial contamination, measurement of CD62P, pH, and platelet aggregation test, to evaluate platelet lesion during storage.

All units were negative for bacterial contamination. Swirling was positive for all units on various days; platelet count was in the acceptable range. Measurement of CD62P on fifth day was not significantly higher than third or first day (P > 0.15) (P > 0.05). pH on fifth day was significantly lower than first day (P < 0.01) (P < 0.05). Platelet aggregation with arachidonic acid and ristocetin showed significant decrease on fifth day compared to third day (P < 0.01) (P < 0.05).

CD62P associated with other platelet function tests can be used as an activation marker in evaluation of PC functions during storage.

We aimed herein to assess demographic, etiological, and clinical characteristics of patients presenting to our hospital’s emergency department with acute poisoning. This study included a total of 509 (0.27%) patients diagnosed with poisoning at our emergency department within a 3-year period. This was a retrospective study. Seventy-one point three (n = 363) percent of the patients were female. The majority of the victims were in the 18-25 years age group (P < 0.001). The poisoning incident was for suicidal purposes in 83.7% of patients. Among the patients presenting with prescription drug poisoning, 92.9% were poisoned in a suicide attempt while 73.2% of patients presenting with poisoning with non-medical substances were poisoned accidentally. Suicidal poisonings were more common in young age group and females (P < 0.001). The most common poisoning agent was antidepressants (17.6%) followed by analgesics (12.8%), and other psychotropic drugs (6.1%). Antidepressant drugs were the most common prescription drugs taken for suicidal purposes (P < 0.001). Poisonings occurred with a single agent in 72.5% of cases and with two or more agents in 27.5% of cases. Analysis of duration of hospital stay revealed that 52.6% (n = 60) of patients stayed in hospital for 2 days. The mortality rate was 0.4%. The majority of poisonings were with prescription drugs, for suicidal purposes, in young age group, and in females. In our study, the three most common agents causing poisoning were antidepressants, analgesics, and other psychotropic substances.

At an estimated incidence of 2 cases per million persons per year, osteosarcoma is the most common primary malignant bone tumor in children and adults, excluding hematopoietic intraosseous tumors. Orbital metastases of osteosarcoma are very rare. Only 5 cases of orbital metastasis of osteosarcoma previously reported in the literature. We report the case of a 19-year-old man with known history of osteosarcoma of right distal femur who presented with acute visual loss and progressive protrusion of his left eye. Orbital CT scan and MRI revealed orbital mass eroding orbital walls and intracranial invasion. He underwent superotemporal orbitotomy for debulking of orbital mass. Histopathological examination (HPE) of the specimen was reported as metastatic osteosarcoma with extensive tumor necrosis. Then he underwent adjuvant chemotherapy and palliative radiotherapy. Although orbital metastasis of osteosarcoma is a rare event, it seems it has had an increasing trend recently. so, making efforts to palliate the patient’s symptoms by multidisciplinary teamwork and proper interaction among ophthalmologist, orthopedic surgeons and oncologists is necessary.

As a polypoid form of capillary hemangioma, lobular capillary hemangioma (LCH) most commonly occurs on the cutaneous and mucosal surfaces and is frequently benign in children. Tracheal LCH is a rare benign tumor in adults, with hemoptysis being one of the most serious forms of presentation. A definite diagnosis of LCH depends on its histopathology. In clinical practice, however, radiological characteristics are an important component for making a suggestive diagnosis. We present a case of tracheal LCH and describe its features on computed tomography, pathology, and differential diagnosis. A review of the relevant literature is also provided.

Mucosal cavernous hemangiomas of maxillary sinus and the lateral nasal wall are seldom encountered and difficult to diagnose with misleading radiologic features like bone erosion and heterogeneity due to patchy contrast uptake. The overall picture mimicking sinonasal malignancy, it is unclear whether there is true breach in the bone or remodeling due to the lesion’s chronicity. Interestingly, it often does not bleed as expected during surgery, questioning the use of therapeutic embolization and pre-intervention vascular shrinkage. The clinical presentation and management protocol of sinonasal cavernous hemangiomas seem greatly individualized. We here present a patient with cavernous hemangioma of maxillary sinus and discuss the distinguishing clinical, histologic and imaging characteristics and subsequent management options, and attempt to establish the findings as the basis of considering it as an important differential diagnosis of radiologically heterogeneous sinonasal mass with suspected bone erosions presenting with nasal obstruction and epistaxis, mostly in young women.

Ewing’s sarcoma is one of the most common primary bone tumors of childhood. The tumor is almost always metaphyseal or diaphyseal, within long bones. In children, lesions of the epiphysis are often benign, with the most common diagnosis being chondroblastoma. Rarely, 1%–2% of Ewing sarcomas may involve epiphysis. We present a case of Ewing’s sarcoma of the proximal humeral epiphysis in a 13-year-old boy. This case adds to previously reported cases of epiphyseal Ewing sarcoma and suggests that the diagnosis should be considered for pediatric epiphyseal lesions.