فهرست مطالب

Archives of Iranian Medicine
Volume:19 Issue: 11, Nov 2016

  • تاریخ انتشار: 1395/09/20
  • تعداد عناوین: 13
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  • Akbar Fazel, Tabar Malekshah, Marsa Zaroudi, Arash Etemadi, Farhad Islami, Sadaf Sepanlou, Maryam Sharafkhah, Abbas, Ali Keshtkar, Hooman Khademi, Hossein Poustchi, Azita Hekmatdoost, Akram Pourshams, Akbar Feiz Sani, Elham Jafari, Farin Kamangar, Sanford M. Dawsey, Christian C. Abnet Page 752
    Background
    Most studies that have evaluated the association between combined lifestyle factors and mortality outcomes have been conducted in populations of developed countries.
    Objectives
    The aim of this study was to examine the association between combined lifestyle scores and risk of all-cause and cause-specific mortality for the first time among Iranian adults.
    Methods
    The study population included 50,045 Iranians, 40 – 75 years of age, who were enrolled in the Golestan Cohort Study, between 2004 and 2008. The lifestyle risk factors used in this study included cigarette smoking, physical inactivity, and Alternative Healthy Eating Index. The lifestyle score ranged from zero (non-healthy) to 3 (most healthy) points. From the study baseline up to analysis, a total of 4691 mortality cases were recorded. Participants with chronic diseases at baseline, outlier reports of calorie intake, missing data, and body mass index of less than 18.5 were excluded from the analyses. Cox regression models were fitted to establish the association between combined lifestyle scores and mortality outcomes.
    Results
    After implementing the exclusion criteria, data from 40,708 participants were included in analyses. During 8.08 years of follow-up, 3,039 cases of all-cause mortality were recorded. The adjusted hazard ratio of a healthy lifestyle score, compared with non-healthy lifestyle score, was 0.68 (95% CI: 0.54, 0.86) for all-cause mortality, 0.53 (95% CI: 0.37, 0.77) for cardiovascular mortality, and 0.82 (95% CI: 0.53, 1.26) for mortality due to cancer. When we excluded the first two years of follow up from the analysis, the protective association between healthy lifestyle score and cardiovascular death did not change much 0.55 (95% CI: 0.36, 0.84), butthe inverse association with all-cause mortality became weaker 0.72 (95% CI: 0.55, 0.94), and the association with cancer mortality was non-significant 0.92 (95% CI: 0.58, 1.48). In the gender-stratified analysis, we found an inverse strong association between adherence to healthy lifestyle and mortality from all causes and cardiovascular disease in either gender, but no significant relationship was seen with mortality from cancer in men or women. Stratified analysis of BMI status revealed an inverse significant association between adherence to healthy lifestyle and mortality from all causes, cardiovascular disease and cancer among non-obese participants.
    Conclusion
    We found evidence indicating that adherence to a healthy lifestyle, compared to non-healthy lifestyle, was associated with decreased risk of all-cause mortality and mortality from cardiovascular diseases in Iranian adults.
    Keywords: Alternative healthy eating index, Golestan cohort study, life style score, mortality
  • Touran Shahraki *, Ivor D. Hill Page 762
    Background
    The clinical manifestations of celiac disease (CD) have changed in the past decades. There are currently little data describing the initial clinical manifestations of CD in children in Iran. This study describes the initial presentation of children with suspected CD from a geographically defined region in Iran.
    Method
    Medical records of children seen in 2007 – 2015 from Sistan and Baluchestan province, Iran, with suspected CD were reviewed. After obtaining TTG-IgA and IgA, subjects were divided into three groups according to presenting symptoms: GI, non-GI, and asymptomatic group. Those with elevated TTG-IgA or a strong clinical suspicion for CD underwent endoscopy with duodenal biopsy. Demographic data, symptoms, laboratory, histopathology findings and the presence of any CD related conditions were recorded.
    Results
    from 344 children who underwent upper endoscopy and intestinal biopsy, 105 cases with marsh 0 – 1 were excluded from the study and 239 cases considered as a definite celiac disease (Mean± SD of age was 6.8 ± 3.9 years with 145 females). GI symptoms were predominant in the younger age groups while non-GI symptoms were more common in the older children. The most frequent GI and Non-GI symptoms were abdominal pain (41.4%), distension (36.4%), diarrhea (32.2%), under nutrition (51.4%), anemia (36.4%), and decreased bone age (35%). The most common co-morbidities were hypothyroidism (3.7%) and Type 1 diabetes (2.9%).
    Conclusion
    GI complaints in Iranian children are a common feature. Screening of children with suspected CD, especially with GI symptom is highly recommended.
    Keywords: Celiac disease, children, disease, Iran
  • Shadi Rahimzadeh, Shohreh Naderimagham, Marzieh Rohani, Rasaf, Parinaz Mehdipour, Masoud Lotfizadeh, Sharareh R. Niakan Kalhori, Fereshteh Davoudi, Atefeh Noori, Kianoush Kamali, Seyed Saeed Hashemi Nazari Page 768
    Background
    The present study describes the epidemiological status of sexually transmitted infections (STIs) in Iran based on the Global Burden of Disease study 2010 (the GBD 2010), and compares this with those of other neighboring countries.
    Methods
    The burden of STIs from 1990 to 2010 in Iran was derived from a systematic study, namely the GBD 2010, which was conducted by the Institute for Health Metrics and Evaluation (IHME). Using a model-based estimation, Disability Adjusted Life Years (DALYs) were calculated on the basis of the prevalence of STIs. The GBD 2010 used disability weights, and a mortality rate that was obtained from the vital registration system of Iran. We review the results of the GBD 2010 estimations for STIs in Iran.
    Results
    The trend of DALYs attributable to STIs (107.3 and 26.47 per 100,000 people in 1990 and 2010, respectively) and deaths (1.13 and 0.12 per 100,000 people in 1990 and 2010, respectively) decreased dramatically in Iran during the last two decades. The majority of individuals affected by STI DALYs were aged 1 – 4 and 20 – 24 years.
    Conclusion
    Since the majority of DALYs attributed to STIs were observed among those aged 1 – 4 years and young people, the economic burden of STIs will remain high in Iran. Therefore, effective evidence-based planning is critical to allocate the essential budget for utilizing treatment and prevention approaches.
    Keywords: Global burden of disease study 2010 (the GBD 2010), Iran, sexually transmitted infections (STIs)
  • Arezou Asgari, Soghra Rouhi Dehnabeh, Mehryar Zargari, Soghra Khani, Hadi Mozafari, Abdolreza Varasteh, Fatemeh Keyfi, Mina Barzegari, Rayhaneh Hasanzaeh, Shohreh Khatami * Page 774
    Background
    Biotinidase deficiency (BTD) is an autosomal recessive disorder of biotin metabolism. Biotin is a coenzyme that enhances the action of the four enzymes that play an important role in carbohydrates, amino acid, and fatty acid metabolism. Defects in these pathways cause severe metabolic disorder in the body. In general, biotinidase deficiency can be classified into two levels: partial and profound. The incidence of BTD is 1:40,000 to 1:60,000 births in the world, even though no convincing statistical data on the prevalence of this disorder exist in Iran. In this study, we aimed to set up a test for determining biotinidase activity among the Iranian population and report BTD mutations.
    PATIENTS AND
    Methods
    The quantitative method for the determination of biotinidase activity was set up in the National Biochemistry Reference Laboratory (NBRL) of Pasteur Institute of Iran in Tehran. To detect mutations in BTD, polymerase chain reaction (PCR) was performed followed by DNA sequencing.
    Results
    The biotinidase activity range values were 3.81 – 8.25 nmol/min/mL. We identified 8 BTD patients out of 47 cases with neurologic signs. We detected two mutations, c.98-104del7ins3 and p.Arg79Cys, in 5 patients with profound BTD, and one p.Asp444His mutation in 3 patients with partial BTD.
    Conclusion
    Infants suffering from BTD seem healthy during their first months of life. At present, the screening program for metabolic disorders such as BTD is in progress. The patients that are BTD deficient benefit from the availability of the tests, and consequently receive the Biotin supplements before being clinically affected.
    Keywords: Biotinidase deficiency, BTD mutations, Iranian population
  • Samira Nozari, Mehdi Mohammadzadeh, Yousef Faridvand, Amir Tockmechi, Aliakbar Movassaghpour, Jalal Abdolalizadeh* Page 779
    Introduction
    Probiotics are live microorganisms, habituated in the human intestine, which have a beneficial effect on our health. In spite of many reports about the anticancer effect of these bacteria in in–vivo and in–vitro, their mechanisms of action are not completely understood. The goal of this study was to compare the extracellular fractions of Lactobacillus casei and L. paracasei on the anti proliferation and apoptosis induction in K562 cell line.
    Materials And Methods
    L. casei and L. paracasei were cultured in MRS broth medium. Then extracellular secretions were collected and after enrichment, analyzed by electrophoresis. Fractionation were determined by gel filtration chromatography using sephadex G100 column, and the anticancer properties were evaluated.
    Results
    The results of SDS–PAGE showed various molecular weight of fractionated proteins of L. casei and L. paracasei. Bioactivity assessment illustrated that anti proliferative effects on K562 cells is dose and time dependent and the cytotoxic effects was parallel with protein concentration and the increase of time from 36 to 72 hours.
    Conclusion
    Regarding the cell cytotoxicity results, the fractionated extracellular proteins of L. casei and L. paracasei have significant effects in inhibition of cancer cell proliferation. However, more study is needed to better elucidate the mechanisms of extracted proteins, and its effect on other human cancer cell lines.
    Keywords: Anticancer, blood cancer, extracellular fraction, gel filtration chromatography, K562
  • *Hakan Ercil, Ergun Alma, Okan Bas, Umut Unal, Nevzat Can Sener, Ediz Vuruskan, Aykut BuĞ, Ra Senturk, Zafer Gokhan Gurbuz Page 786
    Background
    Different energy sources can be used for ureteroscopic stone fragmentation, such as pneumatic, ultrasonic, laser or electrohydraulic. The aim of this study was to compare the efficacy and safety of pneumatic lithotripters versus Ho: YAG laser in the treatment of multiple stones in the distal ureter.
    Methods
    A retrospective evaluation was done using the data of patients to whom ureteroscopic lithotripsy (URL) was applied for ureter stones in our clinic. From these patients, those with multiple unilateral distal ureter stones were identified, then these patients were separated into 2 groups according to the type of lithotriptor used in stone fragmentation as laser lithotripsy (Group 1) and pneumatic lithotripsy (Group 2).
    Results
    Statistically, the two groups were similar in respect of the number of stones, stone burden and the number of double J stents applied intra-operatively. The mean operating time was similar in the 2 groups as 53.47 (±17.3) minutes in Group 1 and 50.59 (±15.3) minutes in Group 2. On postoperative day 1 after the URL, the stone free rate (SFR) of Group 1 (78.7%) was found to be significantly high compared to the SFR of Group 2 (63.6%), while at postoperative month 1, the SFR of both groups was found to be similar. Binary logistic regression was applied to determine the effect of related independent variables on the 1st month SFR. In this model, age and stone burden were affecting variables.
    Conclusion
    Compared to the pneumatic lithotripter, the Ho: YAG laser seems to have advantages of a higher SFR in the early postoperative period, eventhough there are statistically similar success rates and complication rates.
    Keywords: Laser lithotripsy, multiple calculi, pneumatic lithotripsy, ureteral calculi
  • Majid Sartipi, *Saharnaz Nedjat, Mohammad Ali Mansournia, Vali Baigi, Akbar Fotouhi Page 791
    Background
    Some variables like Socioeconomic Status (SES) cannot be directly measured, instead, so-called ‘latent variables’ are measured indirectly through calculating tangible items. There are different methods for measuring latent variables such as data reduction methods e.g. Principal Components Analysis (PCA) and Latent Class Analysis (LCA).
    Objectives
    The purpose of our study was to measure assets index- as a representative of SES- through two methods of Non-Linear PCA (NLPCA) and LCA, and to compare them for choosing the most appropriate model.
    Methods
    This was a cross sectional study in which 1995 respondents filled the questionnaires about their assets in Tehran. The data were analyzed by SPSS 19 (CATPCA command) and SAS 9.2 (PROC LCA command) to estimate their socioeconomic status. The results were compared based on the Intra-class Correlation Coefficient (ICC).
    Results
    The 6 derived classes from LCA based on BIC, were highly consistent with the 6 classes from CATPCA (Categorical PCA) (ICC = 0.87, 95%CI: 0.86 – 0.88).
    Conclusion
    There is no gold standard to measure SES. Therefore, it is not possible to definitely say that a specific method is better than another one. LCA is a complicated method that presents detailed information about latent variables and required one assumption (local independency), while NLPCA is a simple method, which requires more assumptions. Generally, NLPCA seems to be an acceptable method of analysis because of its simplicity and high agreement with LCA.
    Keywords: Index, latent class analysis, principal components analysis, socioeconomic status
  • Vandad Sharifi, Ramin Mojtabai, Zahra Shahrivar, Javad Alaghband, Rad, Hadi Zarafshan*, Lawrence Wissow Page 797
    Background
    The need for mental health care among children and adolescents in Iran, as in other low and middle income countries (LAMIC) remains mostly unmet. In this paper, we sought to provide an overview of the extent of unmet need and mental health services in Iran. We also aimed to propose approaches to address this gap.
    Method
    We reviewed the published epidemiologic studies of child and adolescent mental and behavioral health problems in Iran. We also examined the current status of child mental health services and the gaps between current needs and available services based on published literature that included papers published in scientific journals, as well as governmental and other administrative reports. The contextual issues relevant to child mental health care were also explored, as well as the possibilities to introduce new or scale up promising services.
    Results
    Child and adolescent mental and behavioral health problems are highly prevalent in Iran. Different studies have estimated that 16.7% to 36.4% of children and adolescents suffer from one or more mental health problems. However, there is a serious scarcity of resources to meet this need. Available services are delivered by independent public organizations (e.g., Ministry of Health, Welfare Organization, and Ministry of Education) or private sector with inefficient communication and collaboration among them and no mandatory national mental health policy. Available specialized child and adolescent services are mostly confined to small inpatient units and university outpatient facilities in larger cities, and there is a scarce evidence for the effectiveness of the available services.
    Conclusions
    Expansion of primary care’s role in timely detection and management of child and adolescent mental health problems, implementation of task-shifting and -sharing initiatives, as well as improved collaboration among responsible governmental and non-governmental sectors are some of the most promising future venues to improve mental health care for the Iranian youth.
    Keywords: Adolescent, child, Iran, mental health, mental health services
  • Mansoureh Refaei, Soodabeh Aghababaei *, Abolghasem Pourreza, Seyedeh Zahra Masoumi Page 805
    Background
    Female genital mutilation (FGM) is one of the important aspects of reproductive health. The economic, social and health consequences of FGM threaten the achievement of sustainable development goals. The purpose of this study was to assess the economic, social and reproductive health consequences of FGM from the perspective of individual, family, community and health system.
    Methods
    In this study, we reviewed 1536 articles from 1979 to 2015. Fifty-one studies were directly related to our goal. Research papers, review articles, case studies and books on the research topic were used.
    Results
    The results of this review showed that most studies on FGM, have investigated health complications of FGM, and few studies have addressed its socioeconomic aspects. The complications from the FGM can impose a significant economic burden on individuals, society and health system. Social consequences of FGM are more irritating than health consequences, so to tackle this practice; its social aspects should be more emphasized. Significant short and long term consequences of FGM threaten women’s reproductive health; Reproductive health is one of the essential prerequisites of sustainable development. Sustainable development will be achieved if women are healthy. This practice can threaten achieving sustainable development. In Iran, FGM is performed in some areas, but there are no official statistics about it and there has yet been no plan to deal with FGM.
    Conclusion
    FGM is a form of social injustice which women suffer. Ending FGM requires a deep and long-term commitment. Knowing its consequences and its effects on individual, families, the health system and community will help supporters to continue fighting this practice. Any money spent on eliminating this harmful practice, compared with the costs of complications, would not be wasteful. It seems that further studies are needed to assess socioeconomic effects of FGM and the relationship between type of FGM and induced complications. Such studies will help policymakers to tackle this practice.
    Keywords: Economic consequence, female genital mutilation, reproductive health, social consequence
  • Donya Farrokh*, Elaheh Modoodi, Yalda Fallah Rastegar Page 812
    Primary angiosarcoma of the breast is a rare malignant tumor. Diagnostic breast imaging includes mammography and ultrasound, which are usually nonspecific. A 42-year-old woman with angiosarcoma of the breast is presented. Physical findings showed a hard exophytic mass in the upper part of the left breast, with skin discoloration overlaying the mass. Mammography revealed a high density well defined mass in the left breast, without any micro-calcification and speculation. On ultrasound examination, a hypoechoic mass with a well-defined margin and heterogenous echogenicity was detected. A core needle biopsy and excisional biopsy were performed, and histological examination confirmed the diagnosis of angiosarcoma. The patient underwent simple mastectomy. We present the mammographic and ultrasonographic features of a case of primary breast angiosarcoma with exophytic growth.
    Keywords: Breast neoplasms, hemangiosarcoma, mammography, neoplasm metastasis
  • Erdal Birol Bostanci *, Volkan Oter, Sarper Okten, Nuriye Ozlem KÜÇÜk, Cigdem Soydal, Nesrin Turhan, Musa Akoglu Page 816

    Neuroendocrine tumors (NETs) are rare tumors, but the incidence is increasing with new diagnostics. A 37-year-old man was admitted to our hospital for an incidental 17-mm nodule in the tail of the pancreas. PET/CT shows indeterminate mass in the pancreatic tail with enhanced uptake of 68-Ga-DOTATATE. NET was suspected and laparoscopic distal pancreatectomy was performed. Pathologic examination revealed an accessory spleen with a heterotopic location. To the best of our knowledge, this is the first IPAS case in which the positive 68-Ga-DOTATATE uptake reported in the literature. Our case showed that IPAS is one of the reasons of false positive involvement of 68-Ga-DOTATATE PET/CT. When PET/CT shows an indeterminate mass in the pancreatic tail with enhanced uptake of 68-Ga-DOTATATE, surgeons should keep IPAS in their mind for differential diagnosis to avoid false treatment.

    Keywords: 68, Ga, dotatate PET, CT, intrapancreatic accessory spleen, pancreatic neuroendocrine tumors
  • Mohammad Saeid Rezaee, Zavareh, Mohammad Hossein Khosravi, Seyed Moayed Alavian* Page 820
    Student Research Committee (SRC) has been developed a subset of each university’s Vice chancellor for research in purpose of research training for motivated students and conducting their research interests. In this paper, we evaluated effect of SRCs on Iran’s research through Scopus database and showed that SRCs has a remarkable impact on Iran’s publication performance.
    Keywords: Iran, medicine, research, students
  • Sara Sagharnia, Farideh Darabi, Ahmadreza Jamshidi * Page 821