Archives of Iranian Medicine
Volume:24 Issue: 5, May 2021

In developing countries like Iran, the burden of obesity increases through comorbid diseases. We estimated the mean body mass index (BMI) and prevalence of overweight/obesity by components of sex, age, province, and year in Iran from 1990 to 2016.

Through a comprehensive systematic review, all relevant data sources pooled results with individual level national and sub-national population-based studies. Two stages of age-spatio-temporal modeling and Gaussian process regression were used to estimate mean BMI, followed by estimation of obesity and overweight prevalence through the crosswalk modeling.

In 2016, the age-standardized mean BMI was 27.9 (27.2–28.7) kg/m² in women and 25.9 (25.2–26.5) kg/m² in men. At the same time, the prevalence rates of overweight and obesity were 71.7% (67.9–75.8), and 36.8% (34.1–39.7) in females, and 57.1% (53.7–60.6), and 18.4% (16.9–20) in men. This shows a considerable increase from 1990 when the figures were respectively 24.4 (23.3–25.5) , 36.6% (32.2–41.5), and 8.2% (95% UI: 6.9–9.7) in women, and 23.5 (22.5–24.5), 30% (26.4–34), and 4.7% (4.0–5.5) in men, with 66% attributed to population growth.

Considering the increasing trends of BMI, Sustainable Development Goals (SDGs) seem far out of reach. We need to call for action, aiming for both weight loss strategies and controlling the comorbidities that mediate high BMI risk.

Tofacitinib, a selective inhibitor of JAK/STAT pathway, has recently become available in our region. Here, we examined the safety and efficacy of tofacitinib in active ulcerative colitis (UC).

In a prospective, non-randomized, placebo-free, 52-week clinical trial defined in two phases of induction and maintenance, adult patients with active UC and no response or loss of response to previous conventional treatments, or anti-TNF were recruited (IRCT20181217042020N2). Patients received 10 mg/BID of tofacitinib for 8 weeks. Clinically responding patients were entered into the maintenance phase and received tofacitinib 5 mg/BID for 44 weeks. Clinical evaluation, biochemical tests and endoscopy at time points of baseline, 8, 24 and 52 weeks were performed. The primary outcome was clinical remission at 8 and 52 weeks.

Fifty out of 53 enrolled patients completed the induction phase. Clinical response and clinical remission at 8 weeks occurred in 84% and 9.5%, respectively. Forty-two patients who had clinical response entered the maintenance phase. Clinical remission based on the total Mayo score and the partial Mayo score occurred in 38.9% and 55.3% at 24 weeks and in 61.1% and 72.2% at 52 weeks, respectively. There was significant correlation between the total and partial Mayo score with regard to clinical remission in both 24 and 52 weeks. No serious adverse events, no case of herpes zoster, but two cases of deep vein thrombosis were seen.

Our study showed acceptable efficacy and safety for tofacitinib and suggested a correlation between the total Mayo score with partial Mayo score with regard to clinical remission.

Neurodevelopmental and intellectual impairments are extremely heterogeneous disorders caused by a diverse variety of genes involved in different molecular pathways and networks. Genetic alterations in cilia, highly-conserved organelles with sensorineural and signal transduction roles can compromise their proper functions and lead to so-called “ciliopathies” featuring intellectual disability (ID) or neurodevelopmental disorders as frequent clinical manifestations. Here, we report several Iranian families affected by ID and other ciliopathy-associated features carrying known and novel variants in two ciliary genes; CEP104 and CEP290.

Whole exome and targeted exome sequencing were carried out on affected individuals. Lymphoblastoid cell lines (LCLs) derived from the members of affected families were established for two families carrying CEP104 mutations. RNA and protein expression studies were carried out on these cells using qPCR and Western blot, respectively.

A novel homozygous variant; NM_025114.3:c.7341_7344dupACTT p.(Ser2449Thrfs*8) and four previously reported homozygous variants; NM_025114.3:c.322C>T p.(Arg108*), NM_025114.3:c.4393C>T p.(Arg1465*), NM_025114.3:c.5668G>T p.(Gly1890*) and NM_025114.3:c.1666dupA p.(Ile556Asnfs*20) were identified in CEP290. In two other families, two novel homozygous variants; NM_014704:c.2356_2357insTT p.(Cys786Phefs*11) and NM_014704:c.1901_1902insT p.(Leu634Phefs*33) were identified in CEP104, another ciliary gene. qPCR and Western blot analyses showed significantly lower levels of CEP104 transcripts and protein in patients compared to heterozygous or normal family members.

We emphasize the clinical variability and pleiotropic phenotypes due to the variants of these genes. In conclusion, our findings support the pivotal role of these genes in cognitive and neurodevelopmental features.

To investigate the incidence of nodular and diffuse adenomyosis, concomitant pathologies and also to compare the demographic and clinic differences among patients with adenomyosis and their surgery indications.

This retrospective study was conducted in Tepecik Research Hospital, Izmir, Turkey between 2014 and 2016. Patients were divided into two groups of nodular and diffuse adenomyosis. The following variables were evaluated for both groups: age, gravidity, parity, menopausal status, indication for hysterectomy, ultrasonographic parameters, gynecological symptoms (abnormal uterine bleeding [AUB], pelvic pain and pelvic pressure, postmenopausal vaginal bleeding), preoperative and postoperative histopathological assessment, and coexisting pathologies.

Of the total 3457 cases of hysterectomies, 755 (95% CI: 20.4–23.1) were confirmed with adenomyosis. There were 217 (95% CI: 23.9–30.0) postmenopausal women. Adenomyosis was most commonly detected in patients in the age of 40 to 50 (57.6%). The most common symptoms were AUB (n: 336) (95% CI: 40.9–48.0), pelvic pain or pressure (n:139) (18.4%), and postmenopausal vaginal bleeding (n: 119) (95% CI: 13.1–18,4). Seventy-four (95% CI: 7.9–11.9) of the patients had nodular and 681(95% CI: 88.0–92.3) had diffuse adenomyosis. Demographic data, age, parity, gravidity, endometrial thickness, and menopausal status were similar between the groups. AUB was more frequently detected in nodular adenomyosis (56.8%). Myoma uteri was the main hysterectomy indication in both groups. In addition, treatment-resistant AUB for nodular adenomyosis and endometrial pathologies for diffuse adenomyosis were the most frequent indications for hysterectomy after myoma uteri.

The most common form of adenomyosis was the diffuse form. Endometrial pathologies were more frequently associated with diffuse adenomyosis. Asymptomatic and incidental adenomyosis were more common with the diffuse form. AUB was more frequently detected with nodular adenomyosis.

To evaluate ultrasound (US) characteristics and BI-RADS (Breast imaging-reporting and data system) of malignant breast masses in women <40 years and to compare with older patients.

In a retrospective, descriptive-analytical study, we assessed the US images and BI-RADS category of 78 malignant masses with a final pathology of invasive ductal carcinoma (IDC, NOS type).

Overall, the most frequent US descriptors of IDC were indistinct margin (45%), irregular shaped (63.5%), posterior shadowing (38.8%), heterogeneous internal echogenicity (56.3%) and non-parallel orientation (76.3%). In this study, most malignant masses of young patients were categorized as BI-RADS 4a while in the older patients (over 40), they were mostly BI-RADS 4b and 5 with P=0.03 and odds ratio (OR) of 2.57 (95% confidence interval (CI), 0.74–8.8). In addition, the mean dimension of the mass in young cases was greater (18.3 mm) compared with older patients (13.2 mm) with P value of 0.04 and OR of 3.8 (95% CI, 1.1–13.4).

Similar to previous studies, malignant masses were diagnosed in greater dimensions in younger cases which may be due to the delay in diagnosis, the rapid growth of the tumor and the absence of routine screening guidelines. Radiologists should be aware of the possibility of malignancy in palpable slightly suspicious masses (BI-RADS 4A) in young cases.

Surgical procedures applied in the treatment of early breast cancer (EBC) to achieve satisfactory oncological results lie in a wide spectrum. There has been a major shift toward less-invasive treatments during the past decades. We compared the outcomes of oncoplastic breast surgery (OBS), non-oncoplastic breast conserving surgery (NBCS) and mastectomy in the treatment of EBC.

The records of 412 patients with EBC who underwent OBS, NBCS or mastectomy at our institution between January 2012 and June 2019 were retrospectively analyzed. Postoperative complications, local recurrences (LR) and disease-free survival (DFS) were compared between the groups. EBC patients with unilateral stage-I, IIa and IIb tumors were studied. All patients received adjuvant, targeted and/or endocrine therapy according to the tumor characteristics, followed by radiotherapy (all OBS and NBCS cases, and selected mastectomy patients).

Postoperative complications were similar in all groups except for six fat necrosis and partial nipple-areola necrosis in two diabetic patients treated with OBS. Re-excision rate was lower in OBS (6.5%) than NBCS (8%). There was no statistical difference between the groups regarding recurrence (P=1.000) or DFS (P=0.937).

OBS, NBCS and mastectomy are equally acceptable procedures in EBC in terms of both oncological and surgical aspects.

The WHO and UNICEF have suggested pasteurized donor milk (PDM) as the best alternative for infants who do not receive enough milk from their mothers.

This study aimed to assess the short-term outcomes of launching the first mother’s milk bank in North-West of Iran.

The present retrospective study included 366 premature infants (181 pre-launch and 185 post-launch) who were hospitalized in Al-Zahra Hospital of Tabriz, Iran. The study included infants with birth weight ˂2000 g and/or gestation age ˂32 weeks who were born before and after the launch of mother’s milk bank. Frequency of necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), late onset sepsis (LOS) and mortality rate were compared. Data were analyzed using SPSS 23 with the chisquare test, Fisher exact test, independent t test, and logistic regression test.

In total, NEC grade ≥2 was reported in 9 cases; 8 cases (4.41%) in pre-launch and one case (0.54%) in post-launch (adjusted OR=0.091; 95% CI=0.010 to 0.849, P=0.035). ROP was reported in 21 cases in two groups. Nineteen cases (10.5%) belonged to the pre-launch group and 2 cases (3.7%) to the post-launch group (adjusted OR=0.105; 95% CI=0.022 to 0.488, P=0.004). LOS was also found in 17 cases (9.39%) in the pre-launch group and 4 cases (2.16%) in the post-launch period, suggesting a significant difference between the two groups (adjusted OR=0.297; 95%CI=0.089 to 0.995, P=0.049). There was no significant difference in mortality of infants during hospitalization between the two groups (P=0.789); however, it was decreased from 15 to 8.

Launching the human milk bank significantly improved the outcomes of premature infants.

The coronavirus epidemic first broke out in China in 2019 and spread around the world. Not only the signs, symptoms, and outcomes of the coronavirus in neonates, but also its vertical transmission risks are still unknown. This case series presents eight neonates born to mothers with COVID-19 and two neonates with this infection.

Depression is a chronic and debilitating psychiatric disorder that affects 300 million people worldwide. Pharmacotherapy is one of the treatments. Due to delay in initiating treatment efficacy and the incomplete response to mono-drug therapy in onethird of patients, new approaches need to be considered. One of the ways to overcome this resistance to treatment and to enhance standard medical practice is to add complementary medicines. We aimed to document research progress from studies on integrative medicine for the treatment of depression. Review of PubMed and Scopus databases on the topic and a personal collection of the relevant publications are the sources for this study. Some of the nutraceuticals and complementary medicines in the treatment of depression will be reviewed. Supplements discussed in this review include S-adenosyl-methionine (SAMe), Crocus sativus (Saffron), carnosine, theanine, palmitoylethanolamide (PEA), tryptophan and 5-hydroxytryptophan (5-HTP), gemfibrozil, curcumin (the main active ingredient in turmeric), Hypericum perforatum (St John’s wort), Lavandula angustifolia (Lavender), and Cinnamomum tamala. Despite evidence in favor of the antidepressant effect of several supplements, their efficacy and tolerability should be evaluated and validated by further high-quality studies.

The pathogenesis of the COVID19 pandemic, that has killed one million nine hundred people and infected more the 90 million until end of 2020, has been studied by many researchers. Here, we try to explain its biological behavior based on our recent autopsy information and review of literature.

In this study, patients with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) result were considered eligible for enrollment. Histopathological examinations were done on 13 people who were hospitalized in Afzalipour hospital, Kerman, Iran. Clinical and laboratory data were reviewed. Tissue examination was done by light microscopy, immunohistochemistry and electron microscopy.

The most frequent co-morbidity in the patients was cardiovascular disease. The common initial symptoms of COVID-19 infection were dyspnea and cough. In all cases, the number of white blood cells was higher than the normal range. Common histopathological findings were variable degrees of vasculitis as degenerative to necrotic changes of endothelium and trafficking of inflammatory cells in the vessel wall with fibrinoid necrosis. Tissue damage included interstitial acute inflammatory cells reaction with degenerative to necrotic changes of the parenchymal cells. CD34 and Factor VIII immunohistochemistry staining showed endothelial cell degeneration to necrosis at the vessel wall and infiltration by inflammatory cells. Electron microscopic features confirmed the degenerative damages in the endothelial cells.

Our histopathological studies suggest that the main focus of the viral damage is the endothelial cells (endotheliopathica) in involved organs. Also, our findings suggest that degeneration of leukocytes occurs at the site of inflammation and release of cytokines (leukocytoclastica) resulting in a cytokine storm.

Real-time polymerase chain reaction (RT-PCR) of virus nucleic acid test (NAT) has become the standard method to diagnose severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, there are still many limitations, especially the problem of the high false negative rate. Therefore, the aim of this study was to investigate the positive rate of SARS-CoV-2 NAT and evaluate the diagnostic performance of SARS-CoV-2 IgM and IgG antibody detection in novel coronavirus infection.

A total of 10309 suspected or high-risk cases of infection with SARS-CoV-2 in Wuhan Hubei, China, were tested for virus NAT by RT-PCR. Among those cases, 762 COVID-19 patients and 143 patients with non-COVID-19 who were tested for SARS-CoV-2 IgM and IgG during the NAT period were screened. The difference between the two test methods was analyzed using the chi-square test.

The positive rate of 10309 cases was about 36% (95% CI: 33.39%–39.67%). SARS-CoV-2 was present in various types of specimens, and alveolar lavage fluid had the highest positive rate [52.38% (95% CI: 31.02–73.74)]. The clinical sensitivity of serum SARS-CoV-2 IgM and IgG was 77.17% (588/762) and 94.88% (723/762), respectively, and the clinical specificity was 93.71% (134/143) and 90.21% (129/143). The area under the curve (AUC) of SARS-CoV-2 IgG and combination of IgG with IgM were equally larger than IgM [0.973 (95% CI: 0.964–0.983) vs 0.930 (95% CI: 0.910–0.949)]. IgG antibody had the highest specificity [100.0% (95% CI: 100.00%–100.00%)] and sensitivity [94.0% (95% CI: 92.45%–95.55%)] when detected alone or in combination with IgM antibody. The total coincidence rate of SARS-CoV-2 antibodies detection and SARS-CoV-2 NAT for the diagnosis of SARS-CoV-2 infection was 92.04% (833/905). Among the 34 SARS-CoV-2 NAT-negative patients with clinical symptoms and CT imaging features, 29 (85.29%) patients were positive for SARS-CoV-2 IgM, and 31 (91.76%) were positive for IgG.

SARS-CoV-2 NAT should be considered for many types of specimens, and the combined test of SARS-CoV-2 IgM and IgG can make up for the problem of missed NAT in COVID-19 patients.

To better manage the COVID-19 pandemic, it is necessary to carefully study information about patients with COVID-19.

To report clinical and epidemiological characteristics of COVID-19 patients in southern Iran.

This cross-sectional retrospective study was conducted based on data extracted from the COVID-19 registry of Hormozgan. Data from patients with confirmed COVID-19 based on CT-scan results or real-time reverse transcriptase–polymerase chain reaction (RT-PCR) results until September 25, 2020, were analyzed for this study (2351 inpatients). We reported demographics, signs and symptoms on admission, comorbidities, and treatments, as well as clinical outcomes, hospital stay, and intensive care unit (ICU) admission.

Most of patients were men (1235/2351; 52.5%) and the most common signs and symptoms included cough (1343/2351; 57.1%), shortness of breath (1224/2351; 52.1%) and fever. The most common comorbidities included hypertension (410/2351 (17.4%), diabetes (343/2351; 14.6%) and chronic cardiac disease (282/2351; 12%). Also, 228 patients (9.7%) were hospitalized in the ICU. The mortality rate was 12.5% (295/2351) among all patients and 64.5% (147/228) in ICU wards, respectively. The number of cases with comorbidities including hypertension, chronic cardiac disease, diabetes, chronic neurological disorders, chronic kidney disease, chronic hematologic disease, malignant neoplasm, moderate or severe liver disease, dementia and fauvism in the ICU was significantly higher than the general wards.

Most characteristics of our patients were similar to those reported in other studies; however, our patients were younger and suffered from a less severe disease. The mortality rate in the ICU was higher than other studies.