ARCHIVES OF IRANIAN MEDICINE
Year:2011 | Volume:14 | Issue:5|Papers Count:15

It is an inconvenient truth that for many people tragedy, violence, and bloodshed are more attractive than routine daily peaceful life, hence the journalistic mantra “if it bleeds, it leads.” The Middle East, also known as “the cradle of civilization,” is usually called “the cross-roads of the world” and appears prominently in the media for its long-lasting geopolitical turmoil. Consequently, images of bloodshed dominate the Western imagination of the region. These changes, however, have seriously affected science production so that one cannot study the science growth of the region without considering its geopolitical changes.

Background: Gastro-esophageal reux disease (GERD) has become very common in the past three decades. The reason for this, as well as its exact pathophysiologic mechanisms are yet unknown. In this ecologic study we assessed the relation between water nitrate content and prevalence of GERD in Tehran, Iran.Methods: We determined the prevalence of acid regurgitation (AR) heartburn or any of them occurring on a frequent (at least weekly) or infrequent basis in areas with different water nitrate. The areas for nitrate were defined as below:<50mg nitrate/L, 50 – 74 mg/L, 75 – 100 mg/L, and>100 mg/L. Frequency of each symptom was assessed in each area and compared. Adjustment for age, sex, education, NSAIDconsumption, BMI, smoking, history of GERD in first degree relatives and spouse was done in a multivariate model.Results: People living in areas with water nitrate content more than 100mg/L had a higher chance of suffering from frequent AR than those living in areas with water nitrate less than 100mg/L (25.5% vs.12.0%, OR: 2.53, 95% CI: 1.36 – 4.73, P=0.006). After adjustment for the named factors, the relationship remained significant (OR: 3.65, 95% CI: 1.32 – 10.09). The relation for frequent heartburn or infrequent symptoms was not significant.Conclusion: In this ecologic study, we found relation between experiencing frequent AR and drinking or cooking with water containing more than 100mg nitrate/L. Considering our current knowledge, if we put dietary nitrate into the puzzle of increased prevalence and/or pathophysiology of GERD, it can theoretically answer several questions. Hence we propose a nitrate-hypothesis for GERD pathogenesis.

Background: Worldwide, numerous people of all ages and ethnicities experience asthma. The achievements of current medical regimens for patients frequently depend on three factors: 1) knowledge of patients regarding this disease, 2) patient’s attitude about asthma, including willingness to collaborate with the therapeutic group for disease control, and 3) patient’s self-efcacy for controlling asthma. Therefore, this study examined the relationship between knowledge, attitudes, and self-efcacy with socio-economic factors in Iranian asthmatic patients during 2006–2008.Methods: Participants consisted of 120 adults referred to Milad Hospital, Tehran, Iran during 2006 to 2008 whose physicians diagnosed their asthma. Socio-demographic factors such as sex, age, education level, occupation, marital status, family history of asthma, disease costs, and period of sickness were reviewed. Assessments of knowledge, attitudes and self-efcacy were performed by the Persian version of an international standard questionnaire (KASE-AQ). Data were analyzed by SPSS version 14.Results: Among respondents, only 9 (7.5%) patients had good knowledge about asthma, 108 (90%) patients had a suitable attitude about their asthma and 103 (85.3%) patients had proper self-efcacy. We found a signicant association between self-efcacy and attitude in asthmatic patients (P<0.05).Conclusion: Although specic knowledge about asthma is low, however, favorable attitudes toward asthma create opportunities to intervene and improve asthma management among patients. However, the use of educational tools depends on patients’ educational levels.Therefore, we recommend elevating asthma knowledge.

Background: Alterations of the p53 gene at 17p13.1 as well as the gene for a transmembrane p-glycoprotein, ABCB1 (MDR-1) at 7q21.12, have been shown to be mostly associated with the phenomenon of multi-drug resistance (MDR) in human cancers. In order to better understand the mechanisms by which chemoresistance is mediated, non-hodgkin’s lymphoma (NHL) patients overexpressing p53 mutant protein and resistant to CHOP chemotherapy, NHL patients without p53 overexpression and a Burkitt’s lymphoma Raji cell line with p53 overexpression have been evaluated using uorescent in situ hybridization (FISH) and comparative genomic hybridization (CGH).Methods: Three chromosomes (1, 7, and 17) known to be associated with MDR and the presence of p53 mutant protein, were analysed by FISH.Results: No obvious chromosomal aberrations such as translocations were found in any of the patients when compared to healthy individuals, which suggests that the three selected chromosomes might not be specifically related to NHL, with or without p53 overexpression. For CGH, gains and losses of chromosomal material have been identified and the changes were not only limited to the three selected chromosomes associated with MDR. A detailed analysis of the recurrent aberrations shows that most of the NHL patients have alterations on the chromosome arms 1p, 6q, 7q, 20q, 22q, and Xp, whereas patients with p53 overexpression predominantly show aberrations on 4p and 17q.Conclusion: Further characterisation of the genetic regions identified might more closely contribute to our understanding of acquired MDR in NHL. Alterations in the three evaluated chromosomes may be prevalent in other tumours. In the present study, using FISH and CGH, there was insufficient difference between NHL patients with and without p53 overexpression.

Background: Acute promyelocytic leukemia is a rare indication for hematopoietic stem cell transplantation. Usually it is indicated as consolidation of salvage regimens following relpase. Here we report our experience with stem cell transplantation in acute promyelocytic leukemia patients.Methods: Between 1989 and 2011, we performed 40 hematopoietic stem cell transplantation in first complete remission or relapsed acute promyelocytic leukemia patients. Median age of patients was 23.5 years. Patients received 11 autologous and 29 allogeneic hematopoietic stem cell transplantation from their HLA fully-matched sibling donors. Different conditioning regimens were applied. A total of 24 patients received hematopoietic stem cell transplantation who were in first complete remission and the remainder with a second or more complete remission.Results: Hematopoietic stem cell engraftment was observed in all cases. There were no deaths prior to 100 days after hematopoietic stem cell transplantation. Acute graft versus host disease was mild to moderate in the majority of patients, whereas it was grade III in 4 patients. Chronic graft versus host disease was extensive in 2 cases. With a 4-year median follow up, the relapse rate was 25%. A total of 26 patients are alive. Five year overall survival was 65.5% and 46.8% for allogeneic and autologous hematopoietic stem cell transplantation, respectively.Conclusion: Hematopoietic stem cell transplantation is an acceptable treatment for acute promyelocytic leukemia. Although there is a statistical difference for overall survival between allogeneic or autologous hematopoietic stem cell transplantation, the choice between autologous or allogeneic transplantation needs to have reliable methods for the detection of molecular remission before hematopoietic stem cell transplantation as well as close, reliable follow up of patients with clinical and molecular parameters.

Background: Chronic pain can be associated with limitations in patient function. Assessment of pain-related limitations is one of the important outcome domains that should be considered when designing chronic pain clinical trials. Although a validated instrument for the assessment of pain-related disability in Iranian chronic low back pain (CLBP) patients exists, to date there is no psychometrically sound instrument to measure pain-related physical disability amongst Iranian chronic pain patients suffering from pain in other parts of their bodies.Methods: Six hundred chronic pain patients completed the Modified version of the Roland-Morris disability questionnaire (M-RMDQ) in addition to questionnaires on demographic variables, pain intensity and depression.Results: Internal consistency, test-retest reliability, and concurrent and predictive validity were calculated for the M-RMDQ. Internal consistency of the M-RMDQ items was acceptable (Cronbach’s alpha=0.88). Test-retest reliability with a mean 36-day interval between assessments in 76 chronic pain patients was high (ICC=0.90). Concurrent validity was confirmed via significant correlations between the scores of M-RMDQ, depression and pain intensity. Predictive validity of the M-RMDQ was confirmed as it successfully differentiated pain clinic chronic pain patients from the non-pain clinic chronic pain population.Conclusion: The M-RMDQ has adequate reliability and validity and can be used as a sound measure of physical disability associated with chronic pain among the Iranian population.

Background: Obstructive sleep apnea (OSA) syndrome is one of the most common sleep breathing disorders with significant consequences. The present study aims to determine prevalence of symptoms and risk of OSA in the general population of Kermanshah, Iran.Methods: From 2007–2008 by random-cluster-sampling, 527 adult subjects were selected from the urban region of Kermanshah. The age range of the sample was from 20 to 87 years. Assessment was carried-out using the Berlin questionnaire, a valid scale that determined those at “high risk” and “low risk” for OSA symptoms. Common symptoms were later defined.Results: There were 144 (27.3%) out of the 527 subjects with a mean age of 48.6±16.6 years and a body mass index (BMI) of 25.1±3.3 at high risk for OSA (men 19%; women 8.3%); 261 (49.5%) suffered from snoring with a higher frequency among women (51.5%). From those who snored during sleep, 51 (10%) reported a breathing pause more than once per week. Subjects considered at high risk had a clinical history of diabetes (15.3%) and heart failure (16.7%).Conclusions: Prevalence of symptoms, risk of OSA and associated factors in Kermanshah are noticeable. Considering the adverse effects of this condition on quality of life, further research in an effort for early diagnosis and treatment are recommended.

Background: Cholera has been a significant public health challenge in many communities. An outbreak of acute diarrheal illness occurred among participants in a wedding ceremony in a village in Qazvin, Iran, in 2008. We conducted an epidemiological, environmental and microbiological investigation to determine the causative agent, source and extent of this outbreak.Methods: Clinical and environmental samples were collected and analyzed for the presence of diarrhea-causing bacterial organisms, which included Vibrio cholera. The relationship between the strains was determined using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR).Results: The attack rate was 21.8%. Clinical and environmental samples were positive for v: cholerae serotype Inaba. All tested isolates had a similar ERIC-PCR pattern, which indicated that a single clone of v: cholerae was responsible for this outbreak.Conclusions: Our findings demonstrated that well water was the source of this outbreak.

Venous thromboembolism refers to thrombotic events in the venous system that are most commonly manifested as deep vein thromboses in the upper or lower extremity and/or pulmonary embolism. Venous thromboembolism is a common disorder that is associated with significant mortality, morbidity and health care-related cost. An array of hereditary and acquired risk factors are associated with venous thromboembolism. In recent years, a number of pivotal studies have expanded our understanding of the pathophysiology of venous thromboembolism, and served as the basis for evidence-based guidelines on prevention, diagnosis and treatment of venous thromboembolism. Furthermore, several novel therapeutic agents with different pharmacokinetics, pharmacodynamics and safety profiles have recently become available for treatment and prevention of venous thromboembolism. The purpose of the current paper is to review the pathogenesis and epidemiology of venous thromboembolism as well as an evidence-based approach to the diagnosis and management of venous thromboembolism.

Hip fractures are common and serious consequence of osteoporosis. Bone mineral density (BMD) measurement and the World Health Organization (WHO) fracture risk assessment tool are considered to predict the hip osteoporotic fractures. In this study, their sensitivities in hip fracture cases are evaluated. BMD and WHO probability of fracture risk were determined in 71 hip fractures ³ 50 years of old. Totally, 65% of patients had £-2.5 BMD T score.81% of patients had above the upper interventional threshold of WHO fracture risk probability model. Sensitivities were low in 50 – 59 year age group with progression in older age groups. Results of BMD T score and fracture risk probabilities were not significant between men and women. There were 23% and 49% sensitivities of less than or equal to -2.5 T score in the 50–59 and 60–69 year age groups with a 31% sensitivity of greater than 3% probability of hip fracture risk in the 50–59 year age group, both of which were not valid for predicting hip fracture risk.

Congenital absence of the nose or arhinia is a rare defect of embryogenesis often associated with other anomalies. Arhinia is a life-threatening condition that requires a highly skilled neonatal resuscitation team in the delivery room. The associated anomalies often have a significant effect on the immediate as well as long-term outcome of the neonate. This report presents a case of congenital arhinia and reviews the management of such cases.

Heterotopic pancreas is defined as pancreatic tissue arising ectopically with no vascular or anatomic contiguity with the pancreas proper and is believed to arise embryologically during rotation of the foregut and fusion of the dorsal and ventral pancreatic buds. We report a case of gastric heterotopic pancreas presenting as an obstructive inflammatory mass with the clinical differential diagnosis of gastric carcinoma. A 54 year-old woman presented with a history of four days of severe, acute-onset abdominal pain. Abdominal ultrasound showed a gastric antral mass. This was confirmed on computerized tomography, which revealed a hypo-dense mass with heterogeneous enhancement in the gastric antrum and multiple ill-defined hypo-dense areas in the liver suspicious for metastases. A preoperative diagnosis of malignant neoplasm was strongly favored, and a subtotal gastrectomy was performed. Microscopic examination of the specimen revealed submucosal and deeply seated intra-muscular and mural heterotopic pancreatic tissue, comprised of both ductal and acinar structures, surrounded by exuberant acute and chronic inflammation. The ducts were inflamed and showed marked cytologic atypia, favored to be of reactive nature. There was overlying mucosal ulceration with marked acute and chronic full-thickness gastric mural inflammatory response with abscess formation. This is the second reported case of obstructive gastric heterotopic pancreas, presenting as an inflammatory mural gastric mass.

A 76-year-old male presented to the Outpatient Department of General Surgery at Sikkim Manipal Institute of Medical Sciences with complaints of a pedunculated mass on his right cheek since seven years. The base of the peduncle was surrounded by a bluish red skin lesion, present since 30 years. There was a disproportionate growth of the skin lesion, particularly at the upper one third of the right nasolabial fold since seven years that gradually assumed a pedunculated shape. He denied the lesion being present since birth. Medical history included involution with infection of some areas of the skin lesion in the past. The patient denied having any significant medical problems or any significant allergic history. He was not on any medications. Family history disclosed no similar lesion in the family tree and he belonged to a middle class family.

Golestan Province in northern Iran is known to be a high-risk area for esophageal cancer (EC). Of a long list of multiple risk factors, this study focuses on a possible link between the epidemiologic patterns of EC and the anomalous concentration of some ions and elements in the drinking water sources. A total of 183 samples from 45 villages covering a wide range of EC mortality rates are collected and analyzed. The results demonstrate that NO3–, SO42–, Sb, and Sr exceed the recommended maximum concentration level (MCL) in drinking water. This is more prominent in the villages with high esophageal cancer mortality rate, suggesting a possible link between EC incidence and water quality. Se concentration in drinking water increases from low to the high EC areas, a finding contrary to the expected trend. It is concluded that Se deficiency does not play a major role in the etiology of EC in the Golestan Province. The statistical results obtained from Mann- Whitney and Kruskal-Wallis tests along with cluster analysis are consistent with the observed trend of EC mortality rate in Golestan Province.

Dear Editor: I read with interest the article by Tabatabaei et al.1 on the brilliant description of facial palsy by the genius Persian physician Razi (Rhazez) (865 – 925 AD). The authors have well discussed a very fascinating, albeit challenging, medical condition. The condition is also a multi-disciplinary disease of interest to different subspecialties, including neurologists, neurosurgeons, plastic surgeons, otolaryngologists, ophthalmologists, and psychiatrists.