ARCHIVES OF IRANIAN MEDICINE
Year:2012 | Volume:15 | Issue:4|Papers Count:16

In this issue of the Journal, Roshandel and colleagues present the results of a population-based cancer registry in Golestan Province, in northeastern Iran. The authors should be praised for establishing a population-based cancer registry with high standards in Iran, where there is relatively scant reliable information from comprehensive registries, thus adding to our current knowledge of cancer epidemiology in Iran and the Middle-East.

BACKROUND: Golestan Province, at the western end of the Asian esophageal cancer (EC) belt in northeastern Iran, was reported to have one of the highest worldwide rates of EC in the 1970s. We have previously shown a declining incidence of EC in Golestan during the last decades. This study reports additional new results from the Golestan Population-based Cancer Registry (GPCR).METHODS: The GPCR collected data from newly diagnosed (incident) cancer cases from all 68 public and private diagnostic and therapeutic centers in Golestan Province. CanReg-4 software was used for data entry and analysis based on the guidelines of the International Agency for Research on Cancer (IARC). Age-standardized incidence rates (ASR) of cancers were calculated using the 2000 world standard population.RESULTS: From 2004 through 2008, 9007 new cancer cases were reported to the GPCR. The mean (SD) age was 55.5 (18.6) years, and 54% were diagnosed in men. The ASRs of all cancers were 175.3 and 141.1 per 100,000 person-years for males and females, respectively. Cancers of the stomach (ASR: 30.7), esophagus (24.3), and lung (15.4) were the most common cancers in males. In females, breast cancer (ASR:26.9) was followed by malignancies of the esophagus (19.1) and stomach (12.4). The diagnosis of cancer was based on histopathological reports in 71% and on death certificate only in 9% of cases.CONCLUSIONS: The EC incidence rate continues to decline in Golestan, while the incidence rates of stomach, colorectal, and breast cancers continue to increase.

INTRODUCTION: According to a WHO report, the world will face great changes in the epidemiology of diseases in next three decades. Infectious and communicable diseases will be replaced by mental disorders at an alarming rate (9), making psychiatric disorders the most common cause of disability and premature death. This study compares trends and changes in the mental health of the residents of Tehran  ³ 15 years old) in 1998 and 2007.METHODS: This study was an overview of two cross-sectional, descriptive researches that were performed in 1998 and 2007. The study populations in these two studies were residents of Tehran. Samples were recruited by regular randomized cluster sampling. In both studies, the General Health Questionnaire (GHQ-28) was used to assess mental health. Trained physicians and health experts completed questionnaires, and data were analyzed by SPSS software (Version 18).RESULTS: The results showed that 21.5% of participants in the 1998 survey suffered from mental disorders, of which 27.7% were women and 14.9% were men. In 2007, this figure increased to 34.2% (37.9% in woman and 28.6% in men). The prevalence of mental disorders increased from 1998 until 2007 by about 1.6 fold (1.4 fold for women and 1.9 fold for men). In both studies, the risk of mental disorders increased with increasing age. Anxiety symptoms were more prevalent in both studies compared to somatization, depression, and social dysfunction scales.DISCUSSION: The result shows a dramatic increase of mental disorder prevalence in Tehran from 1998 until 2007. We believe there is a lack of sufficient and qualified facilities for mental health provisions in Tehran. Based on these facts, policymakers and officials have to place greater importance in controlling stressful situations that predispose people to mental disorders, with the intent to improve the mental health of Tehran residents.

BACKGROUND: Mental health is one of the most important public health issues because of its major contribution in decreasing the global burden of disease and its important role in assurance, dynamism, and efficacy. The present study evaluates the prevalence of mental disorders in the over 18-year-old population in Kashan, Iran during 2008–2009.METHODS: This was a descriptive, cross-sectional study. Subjects were selected via stratified random sampling. The study was conducted in two stages. In the first stage, subjects were evaluated using the General Health Questionnaire. In stage two, two psychiatrists used a DSM-IV checklist to conduct clinical interviews. The collected data were analyzed by SPSS version 16, OR, CI, Chi-square, and Mantel-Heanszel tests. RESULTS: The prevalence of mental disorders in Kashan was 29.2%. In women it was 35.5%, and in men, 21.2%. The most prevalent disorders were mood (9.3%) and anxiety disorders (4.7%). Among the 505 subjects with mental disorders based on clinical interviews, 162 (32.1%) suffered from mood disorders, 129 (25.6%) anxiety disorders, 21 (4.2%) psychotic disorders, 16 (3.4 %) neurologic disorders, 17 (3.4%) dissociative disorders, and 120 (23.7%) had other disorders. In this study, 7.8% of the subjects had at least one mental disorder. In the case of mood disorders, major depression (8.2%) was the most common, as for anxiety disorders, generalized anxiety disorder (7.2%) was the most prevalent. The prevalence was higher in people aged 56–65 (35.8%), widows (35.8%), the illiterate (42.8%), and the unemployed (38.8%). Mental disorder was significantly affected by gender, education, occupation, and marital status.CONCLUSIONS: The results show that psychiatric disorders in Kashan are higher than at the time of the previous research in this region (1999). Therefore, prevention programs and treatment of psychiatric disorders in this city are of great priority.

BACKGROUND: Suicide is a critical public health problem. In developing countries, the highest suicide rate is found in young adults with remarkable increasing rate. In this study, we have evaluated the epidemiology and characteristics of 8–16-year-old individuals who attempted suicideand were hospitalized in Loghman-Hakim Hospital, Tehran, Iran from 1997 to 2007.METHODS: A total of 6414 hospitalized patients, ages 8–16, who attempted suicide and were residents of Loghman-Hakim Hospital were investigated. We performed a retrospective chart review to study the characteristics of cases in a 10-year period by review of psychiatric and medical records.RESULTS: Out of 1451 patients, 22.6% were male, 5978 patients were 12–16 years old and the rest were aged 8–12 years. During the 10-year period, suicides showed a rising trend among adults, while in children no significant increase was detected. Communicative disorders were the most common underlying risk factors, particularly in females. One patient out of five cases had psychiatric disorders, of which adjustment disorders were the most predominant. A remarkable peak in suicides was observed in May and July, while winter had the highest suicide rate among seasons.CONCLUSIONS: Suicide due to drug overdose is higher in females than males in young population. This increasing trend is a psychiatric concern and should be resolved by improving mental and public health.

BACKGROUND: Xerostomia is one of the one complications following radiotherapy that can affect quality of life (QoL). This study aims to assess the severity of xerostomia in patients with head and neck cancers after radiotherapy and its effect on QoL.METHODS: In this longitudinal prospective study, the severity of xerostomia and related QoL were was assessed in 63 head and neck cancer patients who referred to the Radiotherapy Ward. Patients completed a xerostomia questionnaire (XQ) at the beginning, and 2, 4, and 6 weeks after treatment over a period of 6 months. Additionally, unstimulated saliva was collected using the spitting method at all 4 visits.RESULTS: QoL significantly worsened with increased time (P = 0.0001), meanwhile, the severity of xerostomia increased significantly (P = 0.0001). However, there was no significant change in the amount of saliva at these 4 time points (P = 0.23). Regression analysis showed that with each milliliter decrease in saliva secretion, the QoL score decreased 2.25%. With one score increase in xerostomia, from the QoL mean score there was a 1.65% decrease.CONCLUSION: The decrease in saliva and xerostomia that resulted from radiotherapy plays an important role in worsening QoL among patients who undergo radiotherapy for head and neck cancers. Although the amount of saliva has a significant association with QoL, the xerostomia score which shows subjects' general feeling also independently impacts QoL. In future studies, we recommend patient assessments for periods longer than 6 months.

BACKGROUND: Little is known about the degree of utilization of information resources on diabetes by general practitioners (GPs) and its impact on their clinical behavior in developing countries. Such information is vital if GPs’ diabetes knowledge is to be improved.METHODS: This cross-sectional study recruited 319 GPs in the summer of 2008. Questions were about the updates on diabetes knowledge in the previous two years, utilization of information resources (domestic and foreign journals, congresses, the Internet, reference books, mass media, and peers), attitude toward the importance of each resource, and impact of each resource on clinical behavior. RESULTS: A total of 62% of GPs had used information resources for improving their knowledge on diabetes in the previous two years. Domestic journals accounted for the highest utilization (30%) and the highest importance score (83 points from 100), with the importance score not being affected by sex, years elapsed after graduation, and numbers of diabetic visits. Clinical behavior was not influenced by the information resources listed, whereas knowledge upgrade, irrespective of the sources utilized, had a significantly positive correlation with clinical behavior.CONCLUSION: Domestic journals constituted the main information resource utilized by the GPs, this resource, however, in tandem with the other information resources on diabetes exerted no significant impact on the GPs’ clinical behavior. In contrast to the developed countries, clinical guidelines do not have any place as a source of information and or practice. Indubitably, the improvement of diabetes knowledge transfer requires serious interventions to improve information resources as well as the structure of scientific gatherings and collaborations.

BACKGROUND: Many studies show that congenital defects in infants conceived by assisted reproductive techniques (ART) are more than infants of normal conception (NC). The aim of this study is to determine the frequency of congenital anomalies in ART infants from Royan Institute and to compare congenital anomalies between two ART techniques.METHODS: In a cross-sectional descriptive study, 400 ART infants from Royan Institute who resided in Tehran were selected by non-random, consecutive sampling. Infants were examined twice (until 9 months of age) by a pediatrician. Infants’ congenital anomalies were described by each body system or organ and type of ART. Data were analyzed by SPSS version 16 and Fisher's exact test.RESULTS: The frequency of different organ involvement in the two examinations were: 40 (10%) skin, 25 (6.2%) urogenital system, 21 (5.2%) gastrointestinal tract, 13 (3.2%) visual, and 8 (2%) cardiovascular system. Major congenital defects in infants conceived by in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) were hypospadiasis, inguinal hernia, patent ductus arteriosus plus ventricular septal defect (PDA + VSD), developmental dysplasia of the hip, lacrimal duct stenosis during the first year of life, hydronephrosis and urinary reflux over grade III, undescending testis, ureteropelvic junction stenosis, and torticoli.CONCLUSIONS: Two-thirds of ART infants had no defects. A total of 7% of IVF and ICSI infants had one of the major abovementioned congenital anomalies. This rate was higher than NC infants (2%–3%). There was no difference between the ICSI and IVF group.

BACKGROUND: Secondary amenorrhea is a condition in which there is cessation of menses after at least one menstruation. It is a symptom of different diseases, such as hormonal disturbances which range from pituitary to ovarian origin, as well as chromosomal abnormalities. Knowledge of the distinct cause of secondary amenorrhea is of tremendous benefit for the management and monitoring of patients. In this study, we determine the chromosomal abnormalities in patients with secondary amenorrhea in Southwest Iran.METHODS: We selected 94 patients with secondary amenorrhea who referred to our Cytogenetic Ward from 2004 until 2009. For karyotyping, peripheral blood lymphocyte cultures were set up by conventional technique.RESULTS: In this study, 5.3% (n=5) of patients with secondary amenorrhea presented with chromosomal abnormalities, of which all contained an X element. The chromosomal abnormalities were:i) 45, X (n=1), ii) 47, XXX (n=1), iii) 45, X [13]/ 45, Xi(X)q[17] (n=1), iv) 45, X[12]/46,X,+mar[12] (n=1), and v) 46,X,del(Xq)(q23q28) (n=1).CONCLUSION: Our study revealed that some causes of secondary amenorrhea could be due to chromosomal abnormalities. Therefore, cytogenetic studies should be important tests in the evaluation of patients with secondary amenorrhea.

BACKGROUND: We used the irradiated homograft rib cartilage as an augmentation tip support and Medpore alloplast for reconstruction of the dorsum in patients with saddle nose deformities. Thereafter, the safety and efficiency of this method was evaluated to determine if this can be a safe and efficient technique for patients with saddle nose deformities.METHODS: A total of 32 patients who suffered from saddle nose deformities due to past trauma or aggressive rhinoplasty underwent reconstruction using the Medpor prosthesis for dorsum reconstruction and irradiated rib cartilage as acolumellar strut during the same technique. After at least one year follow up, patients’ satisfaction and their aesthetic indexes were evaluated and compared with preoperative results.RESULTS: More than 84% of patients were satisfied from the results of the surgery and only one patient had a complication of the infection which resulted in removal of the prosthesis. There were statistically significant differences between most of the pre- and postoperative aesthetic indexes.CONCLUSION: Despite the superiority of autogenous material in nose reconstruction, lack of such materials in revision rhinoplasty cases present challenges to surgeons. This study proposes the safety and efficiency of the Medpor alloplast for reconstruction of the dorsum and irradiated rib cartilage for the tip, at least for a short period of time.

It is currently believed that melamine ingestion can lead to insoluble crystals in an animal's urinary system with subsequent physical obstruction or bladder carcinoma. However, whether melamine can cause injury of other tissues and organs in humans is yet unknown. In this study, we encountered 3 affected children with liver lesions, 2 males and 1 female, and detailed their clinical characterizations. Their ages were respectively 2, 6, and 10 months. Among the 3 patients with liver lesions, only 1 exhibited symptoms of gradual progressive jaundice, abdominal distention, hepatic intumesce, and bilirubin abnormality; the other 2 were asymptomatic. The mechanism associated with liver lesion may, at least in part, be due to physical deposition and blockage of the biliary tract system. Disturbance of the acid-base equilibrium may be another reason that accelerates stone formation in human tissues.

Reciprocal translocations represent one of the most common structural rearrangements observed in humans. Estimates of the population frequency range from 1/673 to 1/1000. We have described two novel balanced translocations in two unrelated families who experienced Recurrent spontaneous abortions (RSA) following their separatenon-consanguineous marriages. Initial cytogenetic studies were performed on cultured blood cells. High resolution GTG-banding analysis using cytovision software performed on their chromosomes revealed a novel balanced translocation t (8,11)(p23,q21) in a brother (45 years) and his sister (27 years) in one family. The second novel balanced translocation t (6,16)(q26,p12) was observed in a consanguineous couple with 4 RSA. These two families have an increased risk of having children with unbalanced karyotypes or RSA, because of incorrect chromosomal segregation during meiosis.

Three patients who came to the surgical outpatient department of ‘Postgraduate Institute of Medical Education and Research’, Chandigarh, India with features suggestive of acute abdomen are presented. On thorough evaluation, they had bilateral psoas abscess and on detailed investigations, tuberculosis was found to be the etiological factor. They were treated conservatively with good follow-up results. Psoas abscess may be clinically difficult to diagnose because of its rarity, insidious onset of the disease, and non-specific clinical presentation which can cause diagnostic delays resulting in high morbidity. Early diagnosis and appropriate management remains a challenge for clinicians. All three patients presented here have recovered following detailed investigation and appropriate management. The diagnosis of spinal tuberculosis should be considered in patients with vertebral osteomyelitis, psoas abscess, and appropriate risk factors such as a history of previous exposure in both developed and developing countries, as tuberculosis is re-emerging as an important etiological factor in spinal pathologies.

A 54-year-old man with sudden onset of rapid progressive generalized skin hyperpigmentation (Figure 1) referred to the Gastroenterology Department of Shariati Hospital, Tehran, Iran in August 2009. He had been assessed for Addison’s disease in the Endocrinology Department 3 months prior because of generalized hyperpigmentation and malaise, but discharged with no certain diagnosis…

Almost four decades ago, an eminent physician, outstanding mentor and scholar, Professor Faramarz Ismail-Beigi (b. 1941) was appointed Chair of the Department of Internal Medicine at Shiraz Medical School. Soon, this proved to be the beginning of a golden era in medical education at that center. Professor Ismail-Beigi invited outstanding teachers and physicians to collaborate with him. Their efforts during the next decade laid a strong and unique foundation for medical education based on quality mentorship and role-modeling.In this paper, we briefly highlight the importance of mentorship in medicine and medical education, followed by a glance at the academic life and career of Professor Ismail-Beigiand and his role as a prominent mentor at the Shiraz School of Medicine.

Serum pepsinogen II (sPGII) is underutilized and considered an inconspicuous biomarker in clinical practice. We refocused on this neglected but novel biomarker and conducted the present study, aiming to elucidate the normal level of sPGII in healthy Chinese patients and to investigate the clinical utility of sPGII for gastric disease screening...