ARCHIVES OF IRANIAN MEDICINE
Year:2015 | Volume:18 | Issue:11|Papers Count:11

BACKGROUND: Comorbidity of psychiatric disorders and substance abuse can intensify both conditions, and when advanced age is added to the combination, the patient will face a distinctive array of issues. This study evaluated the prevalence of psychiatric disorders in elderly substance users as well as certain related factors.METHODS: This cross-sectional study was performed on 160 consenting elderly substance users 60 years and over who had been on methadone maintenance. The subjects were selected from rehabilitation centers affiliated with the Welfare Organization in Tehran through convenience sampling, and were assessed for current or lifetime axis-I psychiatric disorders using the SCID questionnaire.RESULTS: In this study, 28.1% of substance abusers were diagnosed with at least one current psychiatric disorder. Psychiatric disorders were more common in subjects whose dependence had started prior to the age of 35, or those who had a family history of substance use. Also, 34.4% had a lifetime history of at least one psychiatric disorder, with a higher incidence among those simultaneously dependent on other substances in addition to opioids. Major depression was the most prevalent disorder among the study subjects.CONCLUSION: Based on the findings of the present study, axis-I psychiatric disorders are rather common among elderly substance users, and approximately a third of this population have a lifetime history of at least one such disorder. The type of abused substance can affect the incidence of psychiatric disorders, and simultaneous use of non-opioids and other substances can increase their prevalence.

OBJECTIVE: In order to generate local evidence, a case-control study was designed to explore risk factors for suicide attempts (SA) in one of the larger cities in the southeast of Iran–Kerman.METHODS: From one of the main referral hospitals, 300 cases and 300 age- and sex-matched controls were recruited. On top of demographic variables, the following variables were compared in the two groups: personality traits, psychological condition, religiosity, coping skills, general health, and recent stressful events.RESULTS: Having adjusted for recent stressful events as the most important factor (OR = 1.66, P-value < 0.001), the main significant variables were: general health (1.04, P = 0.02), the support of friends (OR = 0.95, P-value = 0.04), being problem-focused mentality (OR = 0.88, P-value = 0.005), and intrinsic religiousness (OR = 0.86, P-value = 0.01).CONCLUSIONS: Although, recent stress increased the risk of SA considerably, other factors such as general health, friends’ support, and being problem-focused may predispose subjects independently. Conversely, intrinsic religious beliefs and close social networks may have protective effects. Therefore, a multi-disciplinary approach is recommended to minimize the burden of SA in Iran.

METHODS: Serum creatinine of 1594 subjects, aged 3 – 18 years, participating in phase 4 of the Tehran Lipid and Glucose Study (2008 – 2011) was measured using the conventional Jaffe method. The non-parametric method of Schwartz and Counahan-Barratt equations were used to calculate eGFR. CLSI/IFCC guidelines were used to determine reference values.RESULTS: In both genders, serum creatinine concentration was significantly increased with age and had a positive correlation with age (boys (r = 0.786, n = 778, P < 0.001) and girls (r = 0.638, n = 724, P < 0.001)). In addition, mean serum creatinine concentration was significantly higher in boys, compared to girls (0.86±0.01 vs. 0.80±0.01 mg/dL, P < 0.001). Based on these results, we proposed the following formula: serum creatinine (mg/dL)=k´age (year)+0.5, where k was 0.03 for boys and 0.02 for girls.CONCLUSIONS: This study presents pediatric reference values in Iranian boys and girls for serum creatinine levels to be 0.6 – 1.20 mg/dL and 0.6 – 1.00 mg/dL and for eGFR values to be 81 – 154 mL/min/1.73 m2 and 80 – 129 mL/min/1.73 m2, respectively. These values can be used for diagnostic and therapeutic purposes.

BACKGROUND: Leukocyte adhesion deficiency type I (LAD-I) is a rare, autosomal recessive inherited immunodeficiency disease. LAD-I is caused by mutations in the ITGB2 gene and characterized by recurrent severe bacterial infections, as well as impaired wound healing with lack of pus formation.METHODS: In this study, we investigated ITGB2 gene mutations in 12 patients and their parents. Genomic DNA was extracted from whole blood samples. All coding regions of the ITGB2 gene were amplified using PCR and followed by direct sequencing.RESULTS: Genetic analysis revealed 12 different homozygous mutations, including six missense (c.382G>A, c.2146G>C, c.715G>A, c.691G>C, C.1777C>T and new C.1685G>A), two new nonsense (c.1336G>T and c.1821C>A), three-frame shift (c.1143delc, c.1907delA and new c.474dupC) and a splice site (c.1877+2T>C). Flow cytometry analysis of CD11/CD18 expression on neutrophils revealed defect in CD18 in all twelve cases (1.4% to 42%), CD11a in ten cases (0.1% to 26.7%), CD11b in nine cases (1.2% to 58.8%), and CD11c in all cases (0% to 18.1%). The patients’ parents were both heterozygous carriers.CONCLUSION: Our findings showed four new mutations in the ITGB2 gene. These results can be used for decisive genetic diagnosis, genetic counseling, as well as prenatal diagnosis for all patients who are suspended to LADI.

BACKGROUND: The aim was to examine the association between 6 single nucleotide polymorphisms (SNPs) of peroxisome proliferator-activated receptors a (PPAR a) poly morphisms and C-reactive protein (CRP) level, as well as additional gene-gene interaction among the 6 SNPs.METHODS: A total of 1260 subjects (583 men, 677 women), with a mean age of 41.3±14.6 years old, were selected. Six SNPs of PPAR a were selected for genotyping in the study including: rs135539, rs 135551 and rs135549, rs1800206, rs1800243, and rs4253623. Linear regression analysis was performed to verify the polymorphism association between SNP with CRP levels. Generalized MDR (GMDR) was employed to analysis the interaction among six SNPs.RESULTS: Linear regression results indicated a significant negative correlation between mutation of rs1800206 and CRP level. The carriers of the V allele (LV + VV) of rs1800206 were associated with a significant decreased level of CRP (regression coefficients was -0.533, standard error was 0.148 (P < 0.001)). However, the other 5 SNPs in PPAR a were not significantly associated with CRP level before or after covariate adjustment. GMDR model indicated that there was a significant two-locus model (P = 0.0107) involving rs1800206 and rs135539, indicating a potential gene–gene interaction between rs1800206 and rs135539. Overall, the two- locus models had a cross-validation consistency of 10 of 10, respectively, and had the testing accuracy of 55.9%, respectively.CONCLUSIONS: Our results support an important association between rs1800206 minor allele (V) of PPAR a and lower CRP level. The interaction analysis showed a combined effect between rs1800206 and rs135539 on the lower CRP level.

BACKGROUND: Previous studies have suggested mesenchymal stem cells (MSCs) as a suitable source for cell replacement therapy in diabetes. MSCs have successfully isolated from different adult and fetal tissues, including the pancreas. In vitro studies have shown that human fetal pancreatic stem cells could be extensively expanded and differentiated into islet-like structures. Here, we introduce a simple and cost-effective method for the generation of MSCs from the human fetal pancreas (FPMSCs).METHODS: To isolate FPMSCs, pancreata from four aborted fetuses (second trimester) were processed with short collagenase digestion. The resulting tissue fragments were transferred to a basic media (DMEM+15%FBS) without adding any growth factor.RESULTS: After 10 to14 days, fibroblast-like cells were harvested and passaged six times for further evaluations. Flow cytometry analysis and three-lineage differentiation capacity have demonstrated that these cells have MSC-like properties. We also continuously passaged samples of FPMSCs and found no evidence for chromosomal instability and morphological changes until 10th subculture. Moreover, our cell culture protocol can be easily modified and translated into a GMP-compliant one.CONCLUSION: The results of current study demonstrated that our simple and inexpensive method could yield a pure population of FPMSCs that might be suitable for transplantation.

BACKGROUND: Non-syndromic autosomal recessive Retinitis Pigmentosa (arRP) is a highly heterogeneous genetic visual disorder with a large number of causative genes. We aimed to determine the power of Whole Exome Sequencing (WES) in the identification of the genes responsible for non-syndromic arRP among Iranian patients.METHODS: We used WES, followed by the Sanger sequencing to identify the underlying gene mutations causing non-syndromic arRP.RESULTS: Our study revealed disease-causing mutations in known arRP genes for 10 of the 13 families studied (76.9%). These mutations included two-frameshift insertion/deletion in CRB1 and ABCA4, one splicing mutation in PDE6B, four missense mutations in RP1, CRB1, PANK2 and IFT140, as well as three stop codon mutations in RDH12, PRCD, and C2orf71. Three remaining families harbored no mutation in previously known RP genes. Of the 10 diseases causing mutations identified among the investigated Iranian patients with non-syndromic arRP, eight variants had not been reported previously. We confirmed segregation of all 10 mutations with disease phenotypes in our studied population.CONCLUSION: This study supports the genetic heterogeneity of non-syndromic arRP in Iranian patients, and provides an opportunity to show the effectiveness of WES in the identification of pathogenic mutations among patients with non-syndromic arRP born to consanguineous parents.

BACKGROUND: Mediterranean diet (MD) has long been suspected to impact on health promotion. Epidemiologic studies reveal the protective role of adherence to this dietary pattern on cancer incidence. However, its association with breast cancer risk remains unclear. Therefore, we aimed to investigate whether adherence to Mediterranean dietary pattern influence on breast cancer risk in postmenopausal and premenopausal women.METHODS: We performed an electronic search of published studies earlier than Apr 2015 using Pubmed, Google scholar, Cochrane and Scopus databases. The search terms included: breast neoplasm, breast tumors, mammary carcinoma, mammary neoplasm, breast cancer, and Mediterranean diet. Study inclusion criteria were: 1) written in English; 2) with a study arm of MD intervention or MD style assessment; 3) reported the BC risk in premenopausal and postmenopausal women.RESULTS: We summarized the findings of 8 studies in this review, including five cohorts and three case-control studies. Although, cohort studies reported controversial results in this field, case-control studies resulted inverse relation between this Mediterranean dietary pattern and breast cancer risk in pre or/and postmenopausal women.CONCLUSIONS: It seems that there is no sufficient data to reach a conclusion about the effect of MD on breast cancer risk in pre and postmenopausal, but there are some evidences suggesting the protective association. More cohort studies in different parts of the world are needed to confirm these results.

Kaposi's Sarcomas (KS) have been associated with many conditions and also known as a typical complication of immunosuppression. It should be considered as an important differential diagnosis in skin lesions of patients after solid organ transplantation. This is a report of a 61-year-old man, who presented with disseminated KS and a history of renal transplantation. We suggest systemic evaluation and visceral assessment in patients with Cutaneous KS.

An aortic saddle embolus causing cauda equine syndrome followed by paraplegia is an exceedingly rare phenomenon in post-operative period in coronary artery bypass grafting. In non-CABG cases, reported documentation of neurological recovery from this event is even rarer. A 57-year-old male 8 days after uneventful OPCAP presented with severe lower extremity pain and sudden fecal and urinary incontinence, followed by the absence of pulsations in the lower limbs and paraplegia, during 20-minute period. He underwent immediate bilateral transfemoral embolectomy. The postoperative period was uneventful. The paraplegia recovered immediately after embolectomy and recovery from anesthesia. An angiography has been made to verify that a high origin of the great radicular artery above T12 level may be responsible for better recovery of paraplegia when its ostium obstructed by a saddle embolus relieved using embolectomy. Early surgical intervention in restoring the blood flow into the great radicular artery may prevent severe histological changes hitherto responsible for non-recovery from paraplegia in the earlier reports. Three unique characteristics of this article are as follows: 1) Occurrence of this complication in the post-operative period in off-pump CABG surgery; 2) Commencing of emboli with bizarre symptoms of double incontinence; 3) Combination of cauda equine syndrome and complete paralysis.

Systemic therapy is one of the cornerstones of cancer treatment. In 1972, following representations by American Society of Clinical Oncology (ASCO), the American Board of Internal Medicine (ABIM) recognized medical oncology as a new subspecialty of internal medicine. Subspecialty of Hematology and Medical Oncology was emerged in Iran in 1983.In the past, modern medical treatments and education were started in Dar Al-fonun school and then in Tehran University; now six universities in Iran are training in Subspecialty of Hematology and Medical Oncology. There are also ten active hematopoietic stem cell transplantation centers, thirty-one provincial medical schools, use their specialized services. Future goals for Hematology and Medical Oncology in Iran include expansion and reinforcement of multidisciplinary teams across the country, early detection and prevention of cancer, providing educational program and conducting cancer researches. To achieve these goals, it is necessary to establish Cancer Hospitals in each province that link together through a network.