Archives of Iranian Medicine
Volume:20 Issue: 5, May 2017

There is limited data on recurrent or persistent pneumonia in children, particularly inthe developing world. This is a retrospective, cross-sectional study of children with recurrent or persistent pneumonia admitted to the Pediatric Department of Massih Daneshvari Hospital, Tehran, Iran.
Children under 18 years of age, who were admitted to the hospital with pneumonia between 2007 and 2013, were investigated to find out the prevalence of recurrent and persistent pneumonia and to recognize their underlying diseases. Descriptive statistics were calculated for all data.
Out of 601 children admitted for pneumonia, 229 (38.1%) met the criteria for recurrent or persistent pneumonia. An underlying illness was identified in 194 patients (84.72%). The most common underlying causes of recurrent pneumonia included aspiration syndrome (51.75%), recurrent wheezing (20.17%), and congenital heart diseases (20.17%). The most common underlying illness of persistent pneumonia included pulmonary tuberculosis (38.75%), recurrent wheezing (28.75%), and aspiration syndrome (26.25%).
The result showed that the majority of patients with recurrent or persistent pneumonia had an underlying illness. New strategies and guidelines are required for early diagnosis of underlying causes of recurrent or persistent pneumonia in children.

Eradication of malaria will depend on discovery of new intervention tools such as anti-malarial drugs. Due to the increasing interest in the application of propolis against significant clinical pathogenic agents, the aim of the present investigation was to evaluate the anti-plasmodial effect of Iranian propolis extracts against chloroquine (CQ)-sensitive Plasmodium falciparum 3D7 and Plasmodium berghei (ANKA strain).
Crude samples of honeybee (Apis mellifera) propolis were collected from four provinces in northern (Kalaleh, Golestan), northeastern (Chenaran, Razavi Khorasan), central (Taleghan, Alborz) and western (Morad Beyg, Hamedan) areas of Iran with different types of flora. The dried propolis samples were extracted with three different solvents, including ethanol 70% (EtOH), ethyl acetate (EA) and dichloromethane (DCM).
All extracts were shown to have in vitro anti-plasmodial activity with IC50 ranging from 16.263 to 80.012 µg/mL using parasite lactate dehydrogenase (pLDH) assay. The DCM extract of Morad Beyg propolis indicated the highest anti-plasmodial activity (IC50: 16.263 ± 2.910 μg/mL; P = 0.027, Kruskal-Wallis H test). The samples were also evaluated in mice for their in vivo anti-plasmodial effect. The curative effect against established infection (Rane test) showed that both extracts at all doses (50, 100, and 200 mg/kgBW) produced anti-plasmodial activity against the parasite. Furthermore, using gas chromatography-mass spectrometry (GC-MS), the quantity of flavonoids in DCM and EtOH 70% extracts were found to be 7.42% and 3.10%, respectively.
The potent anti-plasmodial activity of both EtOH 70% and DCM extracts of the propolis of Morad Beyg, Hamedan suggests further analyses of individual components to assess its utilization as anti-malarial drugs.

There is limited reliable information on abortion in Iran, where abortion is illegal and many women of reproductive age seek clandestine abortion to end their unintended pregnancy. This study aims to examine the determinants of induced abortion in the city of Hamedan, Iran.
The study utilizes recent data from the 2015 Hamedan Survey of Fertility, conducted in a representative sample of 3,000 married women aged 15-49 years in the city of Hamedan, Iran. Binary logistic regression models are used to examine factors associated with the incidence of abortion.
Overall, 3.8% of respondents reported having had an induced abortion in their life. Multivariate results showed that the incidence of abortion was strongly associated with women’s education, type of contraceptive and family income level, after controlling for confounding factors. Women using long-acting contraceptive methods, those educated under high school diploma or postsecondary education, and those with high level of income were more likely to report having an induced abortion.
The high incidence of abortion among less or more educated women and those with high income level signifies unmet family planning needs among these women, which must be addressed by focused reproductive health and family planning programs.

To assess the national health system for management of diabetes mellitus (DM) in Iran, with particular focus on diabetic retinopathy (DR).
In this qualitative study, the national stakeholders related to DR and DM management system were invited to participate. Two researchers performed interview using a semi-structured questionnaire recommended by the World Health Organization titled “Tool for Assessment of Diabetic Retinopathy and DM Management Systems”. The questionnaire contains seven different sections, each consisting of closed and open-ended questions, and a final Likert-type score, ranging from 1 indicating the worst to 4 indicating the best status. Inconsistencies were resolved through a collective decision of the research team, followed by a focus group discussion with stakeholders at the Ministry of Health.
Fourteen stakeholders out of 15 total invitees were interviewed (response rate: 93.3%). There were national priorities, defined policies, and running programs (score = 3), but the care system should be strengthened in terms of implementation of clinical guidelines, with specific reference to the availability of regular screenings for DR (score = 2). The network of care providers, health information systems, and promotional programs were insufficient (score = 2). The health workforce and technology for DR and DM were acceptable (scores 4 and 3, respectively); however, there were concerns about the appropriate distribution and utilization of resources and out-of-pocket costs paid by patients.
The existence of national policies, programs, a qualified workforce, and modern technology is promising. Nevertheless, other aspects of the health system need to be improved to ensure access to health and eye care for people with DM and achieve Universal Health Coverage.

To assess the geographical distribution and time trends of manufactured cigarette and water-pipe use among Iranian adult population.
Pooled data from four consecutive nationally and provincially representative STEPS surveys, 2006-2009, were analyzed. Prevalence of current daily manufactured cigarette smokers, current daily water-pipe and current daily dual users and associated 95%CIs were estimated using complex sample analysis techniques.
Overall, the prevalence of current daily tobacco use, including cigarette and water-pipe, was estimated 23.7% for men and 3.0% for women, in which 20.2% of men and 0.8% of women were exclusively cigarette smokers, 2.7% and 2.2% were exclusively water-pipe users, and 0.6% and 0.01% smoked both cigarettes and water-pipes. The prevalence of cigarette smoking ranged from 12.3% to 27.7% in men and 0.1% to 1.8% in women, and was generally highest in the northwest of the country. Conversely, the prevalence of water-pipe smoking ranged from 1.7% to 10.9% in men and 0% to 16.8% in women, and was highest in the south and southeast. No secular trends were observed for daily cigarette smoking in either men (P = 0.637) or women (P = 0.308) from 2006 to 2009. However, the prevalence of water-pipe decreased slightly in women (P = 0.012) and men (P = 0.055), though the later was not statistically significant.
In Iran, widespread geographical variation in the use of different types of tobacco products should be taken into account when planning for tobacco prevention policies and programs. Iran may serve as an important setting for etiological studies to examine the effects of long-term water pipe use on diseases.

Work-related accidents are believed to be a serious preventable cause of mortality and disability worldwide. This study aimed to provide Bayesian geographical maps of occupational injury rates among workers insured by the Iranian Social Security Organization.
The participants included all insured workers in the Iranian Social Security Organization database in 2012. One of the applications of the Bayesian approach called the Poisson-Gamma model was applied to estimate the relative risk of occupational accidents. Data analysis and mapping were performed using R 3.0.3, Open-Bugs 3.2.3 rev 1012 and ArcMap9.3.
The majority of all 21,484 investigated occupational injury victims were male (98.3%) including 16,443 (76.5%) single workers aged 20 – 29 years. The accidents were more frequent in basic metal, electric, and non-electric machining jobs. About 0.4% (96) of work-related accidents led to death, 2.2% (457) led to disability (partial and total), 4.6% (980) led to fixed compensation, and 92.8% (19,951) of the injured victims recovered completely. The geographical maps of estimated relative risk of occupational accidents were also provided. The results showed that the highest estimations pertained to provinces which were mostly located along mountain chains, some of which are categorized as deprived provinces in Iran.
The study revealed the need for further investigation of the role of economic and climatic factors in high risk areas. The application of geographical mapping together with statistical approaches can provide more accurate tools for policy makers to make better decisions in order to prevent and reduce the risks and adverse outcomes of work-related accidents.

The aim of the paper is to investigate the association between physicians’ adherence to a pharmacotherapy guideline and continuity of care for patients with depressive and/or anxiety disorders in a collaborative care program.
This retrospective observational study was conducted using medical records of subjects suffering from depression and/or anxiety disorder visited by 26 general practitioners (GP) working with Community Mental Health Center (CMHC), who run a collaborative care program in Tehran, Iran. All patients were visited by a general practitioner in private offices from November 2010 to May 2013. A scoring system was utilized to assess physicians’ adherence to the pharmacotherapy guideline using medical records. Patients’ continuity of care was calculated based on the number of days of being in the collaborative care program. To investigate the association between physicians’ adherence to the guideline and the patients’ continuity of care, univariate logistic regression analysis, multiple logistic regression analysis and parametric survival analysis were performed using Stata version 11.
A total of 3,338 patients were studied. Their mean age was 37 years and 81.6% were female. Being treated by a particular GP was an important factor in patients with depressive and/or anxiety diagnosis as well as having both diagnoses. Furthermore, higher score of adherence to the guideline was associated with less continuity of care in depressive patients.
Being treated by certain GPs is an effective way of retention of patients in the treatment. The results demonstrate that patients with guideline-based pharmacotherapy need to be told about

To assess the diagnostic value of three-dimensional steady-state free precession magnetic resonance angiography (3D-SSFP MRA) for detecting coronary artery disease (CAD).
Patients suspected of CAD based on clinical evaluation, underwent invasive coronary angiography (CAG) and Cardiac MRA (CMRA). Collected data in favor of any CAD findings in CMRA were compared to CAG results as the standard diagnostic method in CAD detection. Analysis was performed on per-patient, per-vessel and per-segment bases.
A total of 30 patients (mean age: 43 ± 10 years, 19 men) were enrolled for analysis. On per-patient analysis, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under receiver operator characteristic (ROC) curve of CMRA for detection of coronary artery stenosis were 100% (CI95%: 75% – 100%), 50% (CI95%: 18% – 81%), 73.33% (CI95%: 46% – 90%), 100% (CI95%: 47% – 100%) and 0.827, respectively. On per-vessel analysis, CMRA had a sensitivity of 89.29% (CI95%: 71%-97%), specificity of 80.56% (CI95%: 63% – 91%), PPV of 78.13% (CI95%: 60% – 90%), NPV of 90.63% (CI95%: 74% – 98%) and area under ROC curve of 0.845. On per-segment analysis, sensitivity, specificity, PPV and NPV of CMRA for segmental stenosis detection were 77.78% (CI95%: 60% – 89%), 87% (CI95%: 81% – 92%), 62% (CI95%: 46% – 76%), and 93.89% (CI95%: 88% – 97%), respectively. Area under ROC curve was 0.835 on per-segment analysis.
3D SSFP CMRA provides a promising non-invasive diagnostic tool for assessing coronary artery disease.

The similarities between gametogenic and carcinogenesis processes have been noted for more than decades. Among prominent similarities between these two processes is expression of a group of antigens, namely cancer-testis antigens in both the testes and various cancer tissues. Outer dense fiber (ODF) proteins are testis-specific proteins localized to sperm tails and involved in sperm motility.
We performed a computerized search of the MEDLINE/PUBMED databases with keywords “outer dense fiber, ODF, cancer, testis, gametogenesis and infertility”.
The results of animal and human studies show ODF contribution to male fertility. In addition, ODFs are expressed in some cancers, including prostate adenocarcinoma, breast cancer, chronic myeloid leukemia and basal cell carcinoma.
ODF expression analysis in cancer may pave the way for identification of cancer biomarkers or therapeutic targets.