Archives of Iranian Medicine
Volume:21 Issue: 12, Dec 2018

The Global Burden of Disease (GBD) Study provides estimates of deaths, years of life lost (YLL), years of life lived with disability (YLD), and disability-adjusted life years (DALYs) due to 249 causes of death, 315 diseases and injuries, and 79 behavioral, environmental, occupational, and metabolic risk factors in 195 countries, territories, and regions by sex and 20 age categories in 195 countries and regions since 1990. In this study, we aimed to present the burden of road traffic injuries (RTIs) in Iran and 15 surrounding countries in 1990–2016. The standard Cause of Death Ensemble modeling (CODEm) is used to estimate deaths due to all causes of injury by age, sex, country and year. A range of 27 causes is used for estimating non-fatal health outcomes based on inpatient and outpatient datasets using DisMod-MR 2.0. Disability-adjusted life years (DALYs) estimate quantify the total burden of years lost due to premature death or disability and was computed by summing the fatal burden and non-fatal burden associated with a cause (i.e., YLL+YLD). In 2016, age-standardized transport injuries in Iran accounted for 35.6 (UI: 29.64–43.44) deaths per 100000 compared to 60.8 (UI: 51.04–72.49) in 1990. Transport injury became the fourth leading cause of death in Iran in 2016, up from the 5th leading cause of death in 1990. The burden of RTIs was mainly caused by motor vehicles and motorcycles and mostly affected the economically productive age groups (15–49), males and children, especially those at school age. Afghanistan with 59.14 deaths (52.09–66.8) and UAE with 53.71 deaths (36.59–72.77) had the largest transport injury death rates per 100000. From 1990 to 2016, Iran had -2.06 annual percent change in transport death rates. The lowest annual percent change is reported for Turkmenistan at -3.43. While Pakistan, UAE and Qatar had the highest annual percent change in transport injury. Across all countries, the observed-to-expected ratios for transport injury death rates varied considerably in 2016.The UAE had the largest age-standardized ratios of observed-to-expected rate (2.93), followed by Oman (2.39), Saudi Arabia (2.23), Afghanistan (2.04) and Iran (1.95). RTIs continue to be a public health burden in Iran and its neighboring countries, even though, there is evidence for decline in RTIs across all countries except Pakistan. The most frequent sub-causes of death and injury are the motor vehicle, motorcycle, and pedestrian injuries. The most vulnerable road users are children and young adults.

Running for more than 25 years, the Women Health Volunteers (WHV) program in Iran has made many great achievements. Considering the new expectations from the health system, this national program needs to be revised and undergo fundamental changes. Although many studies have been conducted to evaluate this program, there still is a lack of a comprehensive nationwide assessment containing policy recommendations. This study was conducted in a qualitative approach. The data were obtained from 3 sources: national documentations, semi-structured questionnaires by 49 key informants, and focused group discussions. The program was assessed in 4 domains including the program, goals, achievements, improved opportunities (weaknesses), and strategies for improvements. The collected data were categorized into 4 main themes including goals and objectives, achievements, weaknesses, and recommendations. Main achievements of the WHV program are: increasing people’s participation especially women, increasing health literacy, and increasing coverage and utilization of health services. The most important weaknesses of the program include: lack of a national roadmap and policy plan for the WHV program, lack of true belief in people’s participation in policymakers, weakness in comprehensive system monitoring and evaluation, and inadequate funding. Like many other health system programs in the country, the WHV program suffers from the lack of a binding strategic plan and goal so that by changes in management, sustainability of the program becomes hampered. An appropriate solution would be to operate the WHV program like a non-government organization (NGO) under the supervision of the Ministry of Health and Medical Education (MoHME).

The objective of this study was to compare various lipid ratios for detection of metabolic syndrome (MetS) in the Iranian general population. This cross-sectional study involved 5677 subjects aged ≥18 years from the general population in Kerman, Iran. Associations between lipid ratio quartiles and MetS were analyzed using logistic regression models. The areas under receiver operating characteristic (ROC) was calculated to determine the accuracy of lipid ratios in predicting MetS. The adjusted chance of having MetS across quartiles of all lipid ratios had an increasing significant pattern (P < 0.0001). The area under the curves of triglyceride/high-density-lipoprotein-cholesterol (TG/HDL-C) ratio was 0.85 (95% CI = 0.84–0.87) in men and 0.85 (95% CI = 0.84–0.86) in women, of total cholesterol (TC)/HDL-C ratio was 0.79 (95% CI = 0.77–0.81) in men and 0.79 (95% CI = 0.77–0.81) in women and of low-density-lipoprotein cholesterol (LDL-C)/HDL-C ratio was 0.73 (95% CI = 0.71–0.75) in men and 0.74 (95% CI = 0.72–0.76) in women. Our results indicate that the TG/HDL-C Ratio is a better marker than the LDL-C/HDL-C ratio and the TC/HDL-C ratio for identifying MetS in the Iranian population and could be used in clinical practice

The normal colonic microbiota is associated with the etiology of ulcerative colitis (UC). Several bacterial species are associated with the initiation and amplification of disease process. However, the etiology and mechanism of UC are poorly understood. The present study aimed to investigate, characterize, and compare the main composition of the mucosa-associated intestinal microflora in colonoscopic biopsy specimens of UC and non-UC patients. Aerobic and facultative-anaerobic mucosa-associated bacteria were isolated and diagnosed from colonoscopic biopsy specimens of 40 UC patients and 40 patients without UC. Patients were selected as control from the same centers and colonoscopy was carried out for other reasons (mainly colorectal screening). Isolation and characterization for aerobic and facultative-anaerobic intestinal bacteria were carried out by conventional culture techniques. DNA extraction from biopsies and polymerase chain reaction (PCR) amplification of bacterial 16S rRNA with gene-targeted and species-specific primers was performed for detection of anaerobic bacterial species. Several species of mucosa-associated aerobic and facultative anaerobic bacteria were found in biopsy specimens and there were no significant differences between UC patients and non-UC patients. Our investigation for detection of the anaerobic intestinal flora showed Faecalibacterium prausnitzii, Prevotella, and Peptostreptococcus productus were the predominant microflora in controls and have significant differences (P = 0.002, 0.025 and 0.039, respectively). This is the first investigation of the intestinal mucosa-associated microflora in patients with UC in Iran. These results, although limited by sample size, allow a better understanding of changes in mucosa-associated bacterial flora in these patients, showing that decrease of Faecalibacterium prausnitzii, Provetella, and Peptostreptococcus productus in the intestinal tract may translate into a reduction in the important role of this beneficial bacterial species, which can lead to reduced protection of the gut mucosa and UC development.

Extracorporeal shock wave lithotripsy (ESWL) is considered as the method of choice for treatment of most stone diseases. The present study aims to evaluate radiation dose received by patients undergoing ESWL. In total, 46 patients from both genders were referred to the Shohadaye Ashayer hospital of Khorramabad, Iran and were included in the present study. Patients were positioned in anteroposterior (AP) projection and along 30° anterior oblique (AO) projection upon the X-ray fluoroscopy table and exposures were conducted. Thermoluminescent dosimeters (TLDs) were used for radiation dose measurements. To evaluate the entrance surface dose (ESD), each TLD chip was taped on back of patient at the entrance surfaces of the X-ray beam. The mean number of stones in each patient was 1.4. The stone sizes ranged from 7 to 29 mm, and a mean of 3200 pulses were need for each patient. The mean ESD in the postero-anterior (PA) and oblique X-ray beam entrance were obtained at 12.04 and 68.84 mGy, respectively. There was linear correlation between patient dose with fluoroscopy time, tube current (mA), tube potential (kVp) and patient position (P < 0.001); however, we found no strong correlation between patient dose with patient body mass (P = 0.837), number of shock wave pulses (P = 0.089), stone size (P = 0.773) and locations (P = 0.463). The data obtained in the current study are comparable with information available in the literature. They emphasized that ESWL exposes patients to much more radiation compared to those from conventional radiography and is in the range of computed tomography (CT) procedures. Therefore, following safety guidelines is recommended.

Rickets is failure in mineralization of growing bone and cartilage due to extreme vitamin D deficiency (VDD). The study aimed to identify rickets among vitamin D deficient children and determine any relationship between clinical findings and paraclinical evidence. This study was conducted in two stages. In the first stage, blood was drawn from 406 children aged 30–72 months for measurement of 25(OH)D level. Of these children, 108 had 25(OH)D levels of <20 ng/dL and were evaluated physically for signs and symptoms scores (0-1) of VDD and rickets. Biochemical analysis and radiography of the child’s left wrist and hand was performed. Of the 119 children (29.67%) with 25(OH)D levels of <20 ng/dL, 42 (10.3%) had vitamin D levels of ≤15 ng/dL. There was no correlation between serum 25(OH)D level and levels of calcium (Ca) (r = −0.16), alkaline phosphatase (ALP) (r = −0.12), P (r = 0.13), and parathyroid hormone (PTH) (r = −0.15,) in children with VDD. The mean of signs and symptoms scores had no significant difference between children with (1.59 ± 0.8) and without (1.73 ± 1.01) VDD (P = 0.3). None of the children with VDD had radiographic evidence of rickets. Radiographic data showed that 69.2% (72), 10.6% (11), and 20.2% (21) of the children had delayed, normal, and advanced bone age, respectively. Abnormal radiological findings of rickets were not found on wrist X-rays. Thus, this investigation is not necessary within the range of vitamin D levels described in the current study.

Growing rods are increasingly used for treatment of early onset scoliosis (EOS) worldwide. Beside promising outcomes, some authors are concerned about high rates of complications. In the current clinical trial, complications of EOS surgery using dual growing rods were investigated. Between June 2006 and February 2017, twenty-two consecutive patients with a coronal curve >45 degrees underwent serial surgical correction using dual growing rods at Shafa Orthopedic hospital, Tehran, I.R. Iran. The rods were secured using hooks or screws or both. The patients were followed for 5.2 ± 1.7 years on average. Wilcoxon test was utilized to compare the pre- and post-operative values. P < 0.05 was considered significant. The scoliotic and kyphotic curves decreased significantly from 52 ± 24° to 38 ± 19° and from 78 ± 22° to 60 ± 17°, respectively (P < 0.001). Total rate of implant-related complications (IRCs) and surgical site complications (SSCs) were 54.5% (12 patients) and 22.7% (5 patients), respectively. Malpositioned pedicular screw was found in 2 patients. EOS can be effectively corrected using dual growing rods, however, considerable rates of IRC are of concern (54.5%). It seems necessary to compare the efficacy and complication rate of newer devices with those of growing rods in future studies

The nucleolus is an internuclear organelle without a visible membrane via the light microscope inside the cell nucleus. It is the main site for synthesis of ribosome as a complex machine for coordinating protein production. It forms around a specific chromosomal feature called the nucleolar organizing region (NOR) which possesses numerous ribosomal DNA (rDNA). Although the nucleolus is best known as coordinator of ribosomal biogenesis and protein synthesis, recently, there is exciting awareness both on better understanding of ribosome biogenesis and non-ribosomal nucleolar functions. A great amount of research has clearly indicated that the nucleolus has functional activities in both ribosomal and non-ribosomal conditions such as development, aging, cell cycle, gene stability, lifespan regulation, and progeria. Through recent sophisticated and advanced technologies such as genomics, proteomics, metabolomics, advances of knowledge in RNA species and new approaches in microscopic analysis methods, researchers have shown that perturbation in the nucleolar structure and function (nucleolar stress) have been associated with human diseases including cancer, viral infection, cardiovascular and neurodegenerative diseases. In this review, we discuss the impact of current research providing new information regarding nucleolar roles and functions in some human diseases and aging.

Gastritis cystica profunda (GCP) is a rare condition characterized by polypoid cystic ectasia of the submucosal layer with cystic dilatation of the glandular structures of the stomach. The probable pathogenesis refers to degradation of the integrity of the muscularis mucosa and migration of epithelial cells to the submucosal layer. The most common cause known in the literature for this occurrence is previous stomach surgery. A case presented with two GCP lesions in different locations in the stomach without any history of previous surgery

Extramedullary plasmacytomas occurs in about 20% of multiple myeloma (MM) recurrences. Extramedullary disease seems to respond poorly to thalidomide and has adverse prognostic implication. When disease recurs in the oral cavity with soft tissue infiltration, some authors defend upfront surgical excision prior to radiotherapy with the aim of achieving better local control. We describe herein such an atypical case of recurrence from MM, with complete local response after 2 cycles of chemotherapy. Unfortunately, disease progressed later on, and the patient died after 9 months post-recurrence. This emphasizes the prognostic impact of extramedullary disease manifestation in MM.