Archives of Iranian Medicine
Volume:21 Issue: 4, Apr 2018

The main objective of the Second National Integrated Micronutrient Survey (NIMS-II) was to assess the nutritional status of four micronutrients, namely iron, zinc, and vitamins A and D, and also to conduct an anthropometric assessment of selected groups of children, adolescents, pregnant women, and adults, disaggregated by sex and residential area in nationally representative samples. This paper reports the design of the study along with preliminary findings.
In this study, 32 770 individuals were selected by using single-stage cluster sampling. Venous blood samples were collected on site for laboratory analysis; interviews were conducted, and anthropometric measurements were performed.
The prevalence of anemia was highest (17.1%) among 15- to 23-month-old children; vitamin A deficiency was 18.3% in this age group. As regards iron deficiency anemia, the prevalence in all age/sex groups was less than 5%, ranging from 0.5% in 6-year-old children to 4.2% in 15- to 23-month-old children. Zinc and vitamin D deficiencies were highest among pregnant women (8% and 85.3%, respectively). Finally, the prevalence of overweight and obesity among adults was 40.3% and 29.2%, respectively.
Results of this study can help in designing nutritional intervention programs for nationwide implementation. Of all micronutrient deficiencies, vitamin D deficiency was the most prevalent in all study groups. Thus, appropriate actions should be taken in our community.

Neonatal registry network systems are conducted worldwide in order to improve the quality of neonatal care and also to integrate research into daily practice.
We designed a neonatal registry system and conducted a pilot study in Vali-Asr Hospital to explore its effectiveness to develop an overview of our neonatal status. This study is a report of three years of data registry (2013–2016) in above mentioned system.
Data were collected from 3360 neonates admitted to level 2 of neonatal ward, and NICU (level 3) of the Vali-Asr Hospital. Among them, 184 (5.5%) neonates didn’t survive. The mean ± SD of gestational age (GA) was 35.92 ± 3.352 weeks and the mean ± SD of the birth weight was 2609.23 ± 829.751 g.
This pilot study indicated that the neonatal registry system can help us to have a better overview of the performance of neonatal wards, and also to find new aspects of neonatal disorders. In addition, this study showed that neonatal registry is an essential tool to improve neonatal care.

The present study was conducted to determine the utility of Score for Neonatal Acute Physiology II (SNAP II) and Score for Neonatal Acute Physiology with Perinatal Extension II (SNAPPE II) scoring systems as predictors of neonatal mortality rate, and to compare the predictive value of these two methods.
In this prospective study data were gathered from infants admitted to the neonatal intensive care unit (NICU) of Imam Hossein Medical Center, Tehran, Iran, from March 2015 to December 2015. In addition to demographic data, Apgar score at 5 minutes after birth, initial and final diagnosis, SNAP II, and SNAPPE II were recorded within 24 hours after admission to the NICU.
One hundred ninety-one newborn infants entered into the study. Birth weight (2555 ± 722 g in survival group versus 1588 ± 860 g in expired group, P0.99).
According to our findings SNAP II and SNAPPE II are useful tools in predicting the mortality rate among Iranian neonates admitted to NICU. Although there was no significant difference between SNAP II and SNAPPE II, both methods had a much better predictive value compared to Apgar score at 5 minutes after birth.

Treatment of peritoneal metastases has gained interest among oncologic communities around the world. Cytoreductive surgery (CRS) and hyperthermic intraoperative chemotherapy (HIPEC) have come to be the treatment of choice for selected patients with peritoneal carcinomatosis (PC) in recent years. Prior to HIPEC, patients were treated with palliative support and only guaranteed a few months to live. We reviewed our first 30 patients who underwent CRS and HIPEC. The aim of the study was assessment of the patients’ survival, morbidity, and mortality rate and identifying prognostic factors of patients treated with CRS and HIPEC.
In this cross-sectional study, data were retrospectively collected from 45 patients (15 men and 30 women) who underwent CRS and HIPEC between December 2008 and October 2016, at Nemaazi educational hospital and Shiraz central hospital of Shiraz University of Medical Sciences. Peri-operative and regular follow-up data on survival and complications were gathered and analyzed to identify their prognostic value for survival.
The mean age of the patients was 49.7±16.46 years. The participants in this study consisted of 19 females (63.3%) and 11 males (36.7%). The most common primary tumor was ovarian cancer (30.1%). A completeness of cytoreduction score of CC0/CC1 was obtained in 80% of patients operated on with curative intent. The overall mortality rate was 20%. The 1- and 4-year overall survival (OS) were 89% and 54%, respectively.
CRS and HIPEC are most successful in treatment of selected patients. Development of complete resection with CRS in these 8 years and good OS in our patients encourage us to continue the procedure with all its difficulties and cost.

The goal of many observational studies is to estimate the causal effect of an exposure on an outcome after adjustment for confounders, but there are still some serious errors in adjusting confounders in clinical journals. Standard regression modeling (e.g., ordinary logistic regression) fails to estimate the average effect of exposure in total population in the presence of interaction between exposure and covariates, and also cannot adjust for time-varying confounding appropriately. Moreover, stepwise algorithms of the selection of confounders based on P values may miss important confounders and lead to bias in effect estimates. Causal methods overcome these limitations. We illustrate three causal methods including inverse-probability-of-treatment-weighting (IPTW) and parametric g-formula, with an emphasis on a clever combination of these 2 targeted maximum likelihood estimation (TMLE) which enjoys a double-robust property against bias.

Calpains are a group of non-lysosomal Ca2+dependent cysteine proteases with numerous substrates. Calpains have been identified in almost all eukaryotes and bacteria but not in archaebacteria. In the human genome, this group of enzymes has 15 isoforms and is present ubiquitously and demonstrates tissue-specific patterns of expression. Calpains are involved in different physiological and pathological processes such as cell proliferation, migration, invasion, apoptosis and signal transduction and their roles in various disorders have been reported. In this review, functions of calpains, their substrates, their mechanism of regulation and their involvement in diseases have been summarized.

Isolated macro-nodular liver tuberculosis is a very rare condition. It may mimic primitive or secondary tumors of the liver. This could delay or mislead the therapeutic management. An immunocompetent 48-year-old man with a history of non-metastatic seminoma was treated with right orchidectomy followed by 20 Gy radiotherapy. The discovery, 8 months later, of a 2 cm nodule of the hepatic dome evoked a liver metastasis. Percutaneous biopsy was not feasible. Wedge resection was performed whereas medical treatment would have sufficed, as pathologic examination of the resected specimen showed a macro-nodular hepatic tuberculosis. The patient received anti-tuberculosis drugs for 9 months. The diagnosis of isolated macro-nodular liver tuberculosis is frequently misleading, particularly in immunocompetent and paucisymptomatic patients. Thus percutaneous biopsy is mandatory for diagnosis and also prior to any major surgeries.