Archives of Iranian Medicine
Volume:7 Issue: 4, oct 2004

Background – Rabies is a zoonotic viral disease which infects mammals. It is transmitted to humans and other animals by an infected animal bite. Once the symptoms of the disease develop, rabies is fatal. Rabies is found in all provinces and cities of Iran especially in northern regions, from North-West to North-East of the country. The main objective of this study was to determine the level of antirabies antibody titer in preexposure-vaccinated high-risk individuals working in antirabies treatment centers in Iran and to compare them with WHO standards.Methods – In this study, the serum antibody titers of 2,490 vaccinated high-risk staff working in antirabies treatment centers were surveyed to determine the level of antirabies antibody titers. The titers were then compared with WHO standards. From June, 1999 through June, 2000, rabies antibody titers were measured by ELISA in WHO Collaborating Center for Reference and Research on Rabies, Pasteur Institute of Iran. Antibody titers were classified in 3 groups: 1) below 0.5 IU/mL, 2) 0.5 – 10 IU/mL, and 3) above 10 IU/mL. Results – The antibody titer in the group having received complete vaccination with booster was significantly higher than the group with incomplete vaccination (p < 0.5). The level of antibody titer decreased with time. Our results indicated that this period was about two years for the titers above 10 IU/mL and 5 years for the titers between 0.5 and 10 IU/mL.Conclusion – A booster dose should be injected within a maximum of 2 years which is very important in raising antirabies antibody titer. We concluded that the interval between the last vaccine injection and the time of sampling inversely correlates to the antibody titer

Background – The best way to transport high-risk infants is so called “In utero” transport. In many developed countries, perinatal regionalization programs have been established and expectant mothers and/or their neonates are assigned and referred to different centers according to the level of care they may need. Unfortunately, we do not yet have such a program in Iran; therefore, many of the premature and sick neonates must be transported to the few neonatal intensive care units (NICUs) that are available in Tehran. The present study looks into the problem of neonatal transport in Tehran.Methods – In this study, 16 maternity hospitals in different locations of Tehran were selected randomly for participation in data collection between November 1st – 30th, 2002. Questionnaires regarding clinical data for the participating patients (critically ill neonates) were distributed to the head nurses of selected hospitals. Questionnaires catalogued which patients required transport to NICUs; data were analyzed using SPSS software. Results – During the study period, 3,125 infants were born in the participating hospitals. Three-hundred and twenty patients (10.24%) needed transport but, of these, only 22 (6.87%) infants obtained admission to NICUs. The mean ± SD waiting time for obtaining admission was 110 ± 50 minutes and the mean ± SD elapsed interval between obtaining admission and exit from primary hospital was 50 ± 26 minutes. The reason for transport in 17 of the 22 cases (72.27%) was respiratory distress and in the remaining five (22.73%) the problem was surgical. Three premature infants (of the 22 total referral cases) died before they could get admission. The mean ± SD interval between leaving referring hospital and arriving at referral hospital was 46 ± 17 minutes. None of the health care professionals who accompanied the infants had experience with neonatal tracheal intubation. Conclusion – The neonatal transport in Tehran is not optimal and has many inadequacies regarding communication systems, optimal equipment, trained personnel, etc. We recommend that a perinatal regionalization system to be established in Iran in order to facilitate the detection of high-risk pregnancies and newborns, and to transport them, according to need, to different levels of perinatal care facilities.

Background – Evidence on the provision of smoke-free areas in restaurants is mainly derived from studies in industrialized countries. Evidence from industrializing countries is required for planning a well-coordinated approach to the public health problem of tobacco-related disease in these countries.Methods – To assess public opinion on tobacco control policies in restaurants, a population-based, cross-sectional, random digit-dialing telephone survey was carried out from November 2002 through January 2003. Eight-hundred and ninety-seven randomly selected subjects age 15 years or above were included in the study.Results – Ninety-four point nine percent of respondents (95% confidence interval [CI] 93.5 to 96.4) supported a total smoking ban in restaurants. Reported experiences of discomfort or symptoms from second-hand smoke in restaurants were common. The majority of respondents (60.9%; 95% CI 57.7 to 64.1) anticipated an increase in their frequency of use of restaurants after a total ban. No change in frequency of patronage was predicted by 37.9% of respondents (95% CI 34.7 to 41.1), whereas only 0.7% (95% CI 0.3 to 1.5) stated that they would dine out less often. In multivariate analyses, nonsmokers (adjusted odds ratio 3.2 [95% CI 1.3 to 7.5]) were more likely to support a total smoking ban in restaurants. Conclusion – This first comprehensive survey in Iran shows a strong community support for smoke-free dining.

Background – The prevalence of gestational diabetes mellitus (GDM) is increasing globally, and the major determinants of screening programs are cost-benefit and prevalence in the target population. We aimed at assessing the screening method best-suited for a selected population in Tehran.Methods – A total number of 2,416 pregnant women were classified into high-, intermediate-, and low-risk groups, according to the American Diabetic Association (ADA) criteria. They were then screened for GDM at Tehran’s teaching hospitals using the two-step approach with thresholds of 130 mg/dL and 140 mg/dL, and the diagnostic criteria advocated by Carpenter and Coustan.Results – The prevalence of GDM in our sample was 4.7%. Switching from the 130 mg/dL to the 140 mg/dL threshold, decreased case-detection sensitivity by 12% (to 88%). With this approach, however, the cost of screening per pregnancy dropped from US $3.80 to US $3.20 (-15.6%), and the cost per detected case of GDM, from US $80.56 to US $77.43 (–3.9%).Conclusion – We recommend a universal screening for populations in whom there is a significant prevalence of GDM and variable health-care coverage, leading to a significant proportion of cases being missed, but where the cost of universal screening is markedly lower than that in more developed economies.

Background – Bone marrow transplantation (BMT) and immunosuppressive therapy are two choices of therapy for aplastic anemia. In BMT, abnormal cells are replaced by normal donor’s hematopoetic stem cells in those patients who have an HLA-identical match donor and are aged < 45 years old. In immunosuppressive therapy, antilymphocyte globulin (ALG) and cyclosporin are used in patients who do not have an HLA-identical match donor and are aged > 45 years old.Methods – In this study we compared these two modalities of treatment in acquired severe aplastic anemia. We had 70 patients in two groups. Twenty-nine patients had completed BMT and 41 patients had completed non-BMT treatment. The conditioning regimen in BMT group was cyclophosphamide plus ALG. Patients with severe aplastic anemia who had been referred to the Hematology Clinic of Shariati Hospital from 1990 through 2001, were selected according to age(< 45 or > 45 years) and presence of HLA match donor. Ethical considerations were strictly followed. Data were analyzed by SPSS version 10. Survival probabilities were estimated using Kaplan-Meier method. Results – The 5 years overall survival in BMT group was 67% and in cyclosporin group was 36.6% and we found that after the day 200 posttherapy overall survival in BMT group was higher in comparison with non-BMT treatment (p = 0.02).Conclusion – BMT has the best results and long-term survival in severe aplastic anemia patients.

Background – Alteration in the expression of p53 tumor-suppressor protein is an event that occurs frequently in human cancer, but the practical implications of this phenomenon are yet to be fully exploited. The objective of this study was to determine the value of p53 accumulation as a marker of tumor progression and the relationship between p53 overexpression and clinico-pathologic variables in gastric cancer. Methods – The expression of p53 was studied immunohistochemically in 52 gastric carcinomas using paraffin-embedded gastric tumor tissues. DO7, a monoclonal antibody to p53 protein, was used for the immunohistochemical analysis. The correlation between p53 expression in gastric tumor tissues and clinicopathologic variables was analyzed.Results – P53 positivity was found in 75% of gastric carcinoma cases. A significant correlation between the rate of p53 overexpression and tumor histologic type (p = 0.001), depth of invasion (p value = 0.037), and tumor grade (p = 0.000) was found in the gastric tumors. There was no significant association between p53 protein accumulation and lymph node status (p = 0.591).Conclusion – These results suggest that the preoperative assessment of p53 expression in gastric carcinomas can be helpful to identify patients at high risk of higher grades and more advanced tumors. P53 immunoreactivity cannot, though, predict lymph node status in patients with gastric carcinoma. Furthermore, p53 overexpression is related to gastric cancer progression.

The blood specimen of a 42-year-old male donor was targeted for detailed study at the Iranian National Blood Transfusion Services as the ABO blood grouping of his cells and serum did not match. Preliminary results suggested that his group was “Bombay” (Oh) phenotype. For confirmation, his blood specimen was air-shipped to Bombay, where detailed studies revealed the presence of depressed A antigens on his red cells that were detectable with variable strength with anti-A+B reagents prepared from group O individuals. His red cells failed to show agglutination by anti-H reagents from “Bombay” phenotype, lectin from Ulex europaeus, and immunized chicken. The donor’s serum agglutinated group B red cells showing a titer of up to 1:32 at room temperature, but reacted with A and O red cells only at 4˚C in a low titer of 1:4 – 8. The reactivity against group A and O cells was partially inhibited by saliva from individuals secreting A/H antigens and was characterized as anti-I. The donor was classified as para-Bombay of AHw phenotype. The anti-I antigen strength on the donor’s red cells, as determined by titration of anti-I and anti-i reagents, was comparable to normal adult individuals but not to the “Bombay” phenotype, thus supporting his phenotype as para-Bombay. This case provides another example of the para-Bombay phenotype that serologically differs from the one reported earlier in Iran.

Background – Among the members of Legionellaceae, Legionella pneumophila is involved in more than 95% of cases of severe pneumonia. Isolation of the causative agent from bronchoalveolar lavage (BAL) fluid specimen is a delicate process and also time-consuming. Moreover, it has been shown that some Legionella strains may be viable but cannot be cultured. The serological diagnosis, which is usually determined by the immunofluorescent assay, may also be hindered, due to the delayed rise in Legionella antibody levels with the onset of illness. The aim of this study was to apply PCR method for specific identification of the L. pneumophila in the BAL fluid specimens. Method – In this study, 46 BAL fluid specimens were collected from patients suspected of having Legionnaires’ disease. These samples were kindly provided from educational hospitals of Hamadan and cultured on selective buffered charcoal-yeast extract agar (BCYE) and then tested with specific L. pneumophila PCR. In order to prepare the Legionella DNA, specimens were first treated by proteinase K. DNA was then extracted using the phenol-chloroform method. Specific primers used in this study were those targeting macrophage infectivity potentiator gene of the L. pneumophila.Results – The Legionella DNA was extracted from known strains and then PCR was optimized. The Legionella PCR sensitivity test showed 120 copies of chromosome DNA as a final detection limit. The specificity test did not produce a cross reaction for a range of respiratory pathogenic organisms except for L. pnuemophila. Forty-six BAL fluid specimens were cultured on BCYE medium to isolate the organisms and these were also tested by the PCR. Conclusion – Analysis of the results showed one positive for the culture and four for the specific Legionella PCR. The PCR set that was used showed that it is sensitive enough for identification of L. pneumophila to apply on BAL fluid specimens for the tested samples.

Background – Hypertension is one of the most prevalent chronic diseases. Research has shown that medication noncompliance is the most important reason for poorly controlled hypertension. The objective of this study was to determine the factors, which are associated with medication compliance among hypertensive patients registered in an outpatient clinic. This study was conducted from 23rd July 2002 through 12th April 2003 among 532 hypertensive patients attending the Health-Care Center of Shaheed Motahari Clinic in Shiraz.Method – We carried out a standard interview with 250 patients who met our study inclusion criteria. The data collection included information about sociodemographic variables, variables related to disease and treatment, and patients’ knowledge and attitude. Compliance was defined as the proportion of amount of drugs used by patients compared to the amount of drugs, which had been prescribed.Results – The study group comprised 25- to 65-year-old patients with mean age of 50.6 (SD = 9.7). In 60.4% of the patients compliance was less than 90%. Medication compliance was better among patients who were older than 50 years, were insured, had a good understanding of hypertension and a positive attitude toward antihypertensive drugs, had visited their doctor in shorter intervals, had complications due to hypertension, used other drugs, and had taken antihypertensive drugs for more than 5 years (p < 0.05). In a multiple logistic regression model, having a positive attitude toward antihypertensive drugs and the interval between visit to physician of less than 3 months were two independent predictors of compliance (p < 0.01).Conclusion – Patient’s medication compliance is a multifactor behavior in which the role of patient’s attitude is very important. In order to assess other factors, it is necessary to conduct further research on the patient-physician relationship and methods of providing health care to patients.

Poisoning is a well-known cause of morbidity and mortality in children. This study was done to evaluate the pattern of acute poisoning in children in relation to different age groupings. Pediatric patients hospitalized for acute poisoning at the Amirkola Children''s Hospital, Babol, Iran, over a 6-year period (1995 – 2001) were evaluated prospectively. A special attention was given to poisoning in relation to different age groupings. During the 6-year period, the poisoning cases increased from 18 to 98 (7% vs. 37.5%). Eighty-one percent of children were younger than 6 years of age and had a benign course. The majority of cases occurred in children aged 2 to 6 years. Males under the age of 13 years had a higher frequency of poisoning. Drugs were the most common agents of poisoning in children (31.6%), followed by hydrocarbon chemicals such as kerosene (31.2%). The most frequently implicated drugs were benzodiazepines (17.1%). Poisoning in children less than 2 years old was 37%. They were mostly accidental (82.3%) and the majority of them occurred in summer (34.6%). The highest rate of occurrence of poisoning was recorded between 4 and 8 PM (62%). Acute poisoning in children remains a frequent problem, highlighting the need to develop an education program on primary prevention in our region. Parental education and intensified child supervision are the indicated measures of prevention for unintentional poisoning

Various methods have been used for treatment of postintubation airway stenosis (PIAS). Among these methods resection and anastomosis (RA) is reported to be the most effective. We review our experience with the treatment of a relatively large number of these patients.

Barium enema is one of the best diagnostic tools of the colonic diseases including neoplasms. Complications of this procedure are rare. In this report, we describe one of the rare complications of barium enema with retroperitoneal fibrosis in a 28-year-old woman.

or cryptophthalmos syndrome is a rare autosomal recessive disorder characterized by major features such as cryptophthalmos, syndactyly, and abnormal genitalia. Consanguinity is reported in 15 – 24.8% of the cases. The diagnosis of this syndrome can be made on clinical examination; therefore we present the clinical findings of a rare case of Fraser syndrome in a female infant.