Archives of Iranian Medicine
Volume:19 Issue: 7, Jul 2016

Hypertension is a major risk factor for non-communicable diseases. Yet, Nation-wide prevalence and trend reports in developing countries are sparsely available.
Data from three cycles of Survey of Risk Factors of Non-communicable Diseases (SuRFNCD) 2005 & 2011 were aggregated. In 2011, 8218 adults aged 25 – 70 years were enrolled. For trend analysis 68850, 4184, and 7416 adults aged 25 – 64 years were included from 2005, 2007, and 2011 surveys, respectively. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, or receiving anti-hypertensive medication. Pre-hypertension was defined as SBP between 120 – 139 or DBP between 80 – 89 mmHg. The status of awareness, non-pharmacologic treatment (management), pharmacologic treatment, and control (SBP 25.6% (95%CI: 23.5 – 27.5) of the adults aged 25 – 70 years had hypertension and 39.8% (95%CI: 37.8 – 41.9) had pre-hypertension. The prevalence of hypertension was greater among older adults (P The prevalence of hypertension and pre-hypertension is gradually declining. Despite improvements in awareness, management, treatment and control, these decline rates are still low and initiative strategies need to be implemented to further improve the current status.

There are many factors that affect intrauterine insemination (IUI) success rate and identifying those factors can be helpful. This study aimed to investigate the single versus double IUI in controlled ovarian hyperstimulation cycles.
This is a randomized clinical trial with equal randomization (1:1) conducted on 580 women who underwent IUI in a private infertility clinic from May 2013 to November 2014 in Rasht, Iran. Women were randomly assigned to single (n = 290) or double (n = 290) IUI groups. Women in the single group underwent IUI performed 36 h after human chorionic gonadotropin (HCG) administration. Women in the double group underwent two IUIs performed 18 and 40 hours after HCG administration. The main outcome was clinical pregnancy confirmed by evidence of fetal cardiac activity. Data were analyzed by SPSS software. Comparisons of frequencies were done using the Fisher exact test and Chi-square test. For comparing means between the two groups, the independent t-test was used. The P-value Pregnancy rate was 11.7% (34/290) in the single IUI group and 13.4% (39/249) in the double IUI group. The difference between the two groups was not statistically significant (P = 0.617, OR = 1.17, 95% CI: 0.72 – 1.91). Also, we could not show significant difference between single and double IUI groups in different cause of infertility groups regarding the success rate.
Based on findings, double versus single IUI did not increase the pregnancy rate of IUI and further investigations are recommended.

Previous studies reported the association between dietary patterns and prevalence of diabetes, cardiovascular disease and other chronic disease. However, there are no studies reporting major dietary patterns in patients awaiting coronary artery bypass graft surgery (CABG). The aim of this study was to obtain the major dietary patterns and their association with demographic, dietary factors and biochemical parameters in these patients.
MATHERIALS AND This was a cross-sectional study on 454 patients aged 35 – 80 years as candidates of CABG and hospitalized in the Tehran Heart Center. Anthropometric and demographic characteristics were obtained from all participants and a 138-item semi-quantitative food frequency questionnaire (FFQ) was used to evaluate dietary patterns by factor analysis. Biochemical parameters including HbA1c, serum lipids, hematocrit (HCT), albumin, creatinine and CRP were assessed by commercial laboratory methods.
Five major dietary patterns, including: healthy, intermediate, neo-traditional, western and semi-Mediterranean patterns were extracted. Top quartile of healthy pattern was associated with higher educational attainment and lower serum low-density lipoprotein cholesterol (LDL), and total cholesterol (TC) in men, as well as higher high-density lipoprotein cholesterol (HDL) concentrations in women (P There were five major dietary patterns using FFQ among patients awaiting CABG surgery. Significant associations were observed between major dietary patterns and risk of diabetes and hypertension. Top quartiles of healthy eating patterns were associated with lower cardio-metabolic risk factors.

Financial protection of household against the consequences of the health care expenditures is one of the most important functions of health care systems. The objective of this study was to determine the equity in health care payments and determining factors among households in Hamedan, a province in Iran.
In this cross-sectional study, 772 families of patients, who were being discharged from hospitals in Hamedan, were selected for study by using a stratified random sampling method. Required data regarding households’ health and non-health expenditures were collected through World Health Organization standard questionnaire by interviews and observation method.
According to the findings, 20.7% of households experienced catastrophic health expenditure. The incidence of impoverishment due to out-of-pocket payments for health care was 2.8% among studied households. The highest incidence rate of out-of-pocket health payment indices occurred in the first quintile (poorest or Q1). Variables such as having members under 6 years or over 60 years in household, household size, employment of household head, household's income quintile, existence of the disabled member in households and the education level of the household’s head are the most important factors that affect the incidence of out-of-pocket health payment indices.
There is considerable inequity in health care financing as well as household's health payments. This requires designing and implementing the operative and protective programs for understanding the important factors that affect equity in health financing, especially for poor households, against the unexpected health expenditures through the health care system.

Prostatic stromal tumors of uncertain malignant potential (STUMPs) are rare tumors arising from the specialized prostatic stroma. These tumors share certain histological and clinical features of benign prostatic hyperplasia, resulting in misdiagnosis of STUMP as prostatic hyperplasia. However, in contrast to prostatic hyperplasia, occasional cases have been documented to recur rapidly after resection and few of them have progressed to prostatic stromal sarcoma and distant metastasis. In this study, we aimed to estimate the prevalence of prostatic STUMP in specimens initially diagnosed as prostatic hyperplasia.
MATHERIAL AND A total of 702 consecutive pathology slides with a diagnosis of prostatic hyperplasia between 2009 to 2014 in specimens were obtained by prostatectomy or trans- urethral resection of the prostate. Those slides were submitted to Faghihi hospital, affiliated to Shiraz University of Medical Sciences, and were reviewed retrospectively in order to search the findings in favor of STUMP.
Based on histological findings, STUMP was identified in 3 cases (0.43%), which revealed hypercellular stroma, infiltrating between the hyperplastic glands. Cells showed some degree of pleomorphism, nuclei with vesicular chromatin and few mitotic figures. No recurrence was reported in patients.
Although STUMP can be histologically and clinically misdiagnosed as BPH, the differences in prognosis and treatment modalities highlight the importance of rendering the correct diagnosis.

Iatrogenic tracheal rupture is a rare complication after intubation. Overinflation of the tracheal cuff was speculated to be a frequent cause of tracheal rupture. The surgical approach is a widespread treatment for tracheal ruptures. The aim of this study is to evaluate the results of conservative and surgical therapy approaches in tracheal rupture cases inflicted by tracheal intubation.
Data on 12 patients who experienced tracheal ruptures secondary to intubation were reviewed. The average age of the patients was 58 years (range of 38 to 81 years). Six patients were men and 6 patients were women. Four of the patients were performed thoracotomy for primary surgery and underwent surgical therapy. 8 patients were treated conservatively. The results of both approaches were evaluated.
Patients, who underwent both conservative and surgical therapy, were completely recovered. There was no rupture originated complication or death.
Both conservative and surgical therapies are appropriate for treatment of membranous tracheal rupture.

Design and validation of Real-time PCR on the protected gene region ITS2 to quantify the parasite load in common leishmania (L) species.
Probe and primer were designed from the ITS2 region between the rRNA genes with minimum gene variation in three common leishmania species followed by a Real-Time PCR using the Taq man probe method in the form of absolute quantification. A series of different concentrations of leishmania were analyzed. After the purified PCR product was successfully placed in a PTG19-T plasmid vector, specialized ITS2 region was cloned in this plasmid. In the last phase, the cloned gene was transferred to the Ecoli.Top10F bacteria. The standard plasmid was provided in 107 to 101 copies/rxn concentrations. The specification and clinical sensitivity of the data was analyzed using inter and intra scales.
The probe and primer were designed using three species, including L. infantum, L. major, and L.tropica. Seven concentrations of purified parasite in culture media showed that the selected region for quantifying the parasite is suitable. Clinical and analytical specificity and sensitivity were both 100%, respectively.
The Taq man method for the ITS2 region in leishmania is one the most sensitive diagnostic test for identifying the parasite load and is suggested as a tool for fast identification and quantification of species.

Human rabies is preventable by prompt application of post-exposure prophylaxis (PEP). The aim of this study was to compare the adverse reactions of purified vero cell rabies vaccine (PVRV) with purified chick embryo cell vaccine (PCECV) vaccination for the PEP.
In this double blind clinical trial study, 1449 people bitten by animals (279 females), were recruited from 9 different cities of Iran, and randomly assigned to receive intramuscular injections of the PVRV (n = 702) and PCECV (n = 747) vaccines in 5-dose regimen. The local and systemic adverse reactions were compared between two groups.
The mean age was 26.8 years (SD, ± 13.1 years) and 27.4 years (SD, ±13.9 years) in PVRV and PCECV group, respectively. Bites were most often located on the lower extremities in both groups. The most common local adverse reaction in both groups was pain at the injection site (4%). Most of the reported systemic adverse reactions were headache (2.5%) and fever (1.9%) in PCECV and PVRV group, respectively. The incidence of itching was higher in the PVRV group compared to the PCECV group (1% vs. 0.1%) (P The results of the present study indicated that PCECV vaccination was associated with fewer itching at the injection site. There was no significant difference between PCECV and PVRV vaccine regarding local and systemic adverse reactions. Therefore, the PCECV vaccine can be administered instead of PVRV, when our country encounters serious challenges in PVRV vaccine supply.

Long non-coding RNA (lncRNA) genes are an important population of non-coding RNAs with defined key roles in normal development as well as tumorigenesis process. Evidences suggest that they can be classified as tumor suppressor genes or oncogenes according to their functions and expression pattern in tumoral tissues. They have been shown to regulate the plasticity of cancer stem cells. Their important roles in the regulation of cancer-related pathways in addition to deregulation of their expression in a number of cancers have suggested that they can be used as markers for cancer detection and prognosis, as well as targets for cancer treatment. Deregulation of a number of lncRNAs, such as HOTAIR, XIST, MALAT, and H19 has been detected in breast cancer samples and cell lines. In addition, the association between lncRNAs signature and breast cancer patients’ survival has been assessed in various studies. Here, the expression patterns of lncRNAs in breast cancer, as well as their significance in prognosis and patient treatment are discussed.

Neurofibromatosis type 2 mostly develops with multiple neoplasms of the central and peripheral nervous system and is associated with ocular abnormalities.
The presented case is a 19-year-old female patient with bilateral vestibulocochlear schwannomas in both pontocerebellar corners, intradural intra-extramedullary masses, and multiple neurofibromas in the spinal canal.
The clinical picture for NF-2, also called central neurofibromatosis, is completely different from von Recklinghausen disease. Untreated bilateral vestibulocochlear schwannoma may cause hydrocephalus in NF-2, and lead to death. Therefore, it is recommended to carefully monitor and treat bilateral vestibulocochlear schwannoma in accordance with its stage.

Ruptured hepatic artery pseudoaneurysm (HAP) generally leads to the hemobilia and can be diagnosed by endoscopy. This condition mostly occurs after an iatrogenic trauma. The management of the HAP is still a big challenge. Due to an increased rate of HAP cases over the last decade, appropriate management is necessary for the optimal outcomes achievement. Here, we report a 59-year-old woman presenting with hematemesis, melena, hematochezia, and epigastric pain. The CT scan of the abdomen showed intrahepatic biliay dilation with hypodense material, probably a clot inside it. Subsequently, the patient was transferred to an angiography unit. Celiac artery angiography demonstrated a right hepatic artery pseudoaneurysm, which subsequently embolized.