ARCHIVES OF IRANIAN MEDICINE
Year:2016 | Volume:19 | Issue:8|Papers Count:14

BACKGROUND: This study aims to compare the dietary and physical activity (PA) habits in a nationally representative sample of Iranian children and adolescents based on their family and regional socioeconomic status (SES). METHOD: This nationwide study was conducted on 14,880 students, aged 6-18 years, and one of their parents living in urban and rural areas of 30 provinces in Iran. Data regarding PA, screen time and dietary habits were recorded using two sets of questionnaires for both students and their parents. The results were compared according to the SES of the family and the living region. RESULT: Overall, 13,486 students completed the study (90.6% participation rate) with a mean age of 12.5 (95% CI: 12.3-12.6) years. Comparing family SES, the level of PA was similar in the three SES groups. The total screen time, working computer with and watching TV was significantly higher in those with higher family SES (P<0.05). Consumption of meat, dairy products, rice, fruit, and vegetables was significantly higher in families with higher SES. Consumption of salty snacks and sweet drinks was significantly lower in families with higher SES level. Sedentary lifestyle was more prevalent in regions with higher SES. The dietary habits of inhabitants of regions with low SES was similar to that reported for individuals with low family SES. CONCLUSION: Both family and regional SES might impact lifestyle habits from early life. Participants with higher SES had healthier dietary habits but lower PA level than their counterparts with lower SES. Socioeconomic disparities should be considered for public health interventions aiming to improve lifestyle habits.

BACKGROUND: Acute Post ERCP Pancreatitis (PEP) is the most common major complication of Endoscopic retrograde cholangiopancreatography (ERCP). The aim of the current study was to assess the utility of single dose rectal indomethacin with and without intravenous perfusion of normal saline to prevent acute pancreatitis. METHODS: In this randomized clinical trial, 406 patients with choledocolithiasis underwent ERCP. Based on computer-generated numbers, the patients were allocated into 4 groups, each group receiving a different intervention prior to the ERCP procedure. The interventions included rectal indomethacin (100mg) in the first group, intravenous (IV) saline perfusion in the second, both rectal indomethacin and IV saline in the third, and the fourth (control) group receiving rectal glycerin. Serum amylase levels were measured and clinical pancreatitis episodes were quantified and classified according to APACHE II prognostic criteria. Statistical inference was performed using the chi-square or Fisher’s exact test for qualitative variables, while Student’s zxA-test was used for quantitative variables.RESULTS: A diagnosis of mild pancreatitis was present in 38 (9.4%) cases. The numbers of events in the four study groups were 11, 10, 0, and 17, respectively, corresponding to an absolute risk reduction of 5.2%, 6.2%, 16.2% (number needed to prevent one episode of PEP) and a relative risk reduction of 32%, 38% and 100% in the three study groups, respectively. The frequency of PEP was only significant in the third group (P˂0.001).CONCLUSIONS: The combination of rectal indomethacin and intravenous normal saline before ERCP significantly prevents post-ERCP pancreatitis.

BACKGROUND: Common variable immunodeficiency (CVID) is a primary immune deficiency with heterogeneous complications. The purpose of this study is to determine disease severity in a cohort of CVID patients based on the suggested scoring system and investigate predisposing factors which would be helpful to predict the severity of the disease. METHODS: The study population comprised 113 CVID patients (69 males and 44 females) who were visited at Children’s Medical Center (Pediatrics Center of Excellence affiliated to Tehran University of Medical Sciences, Tehran, Iran) during the last 30 years (from 1984-2014). According to a suggested severity scoring system, patients were divided into two groups, A and B. The clinical severity of the disease in patients was assessed with severity scores including 15 unlucky complications of the disease such as numbers of past meningitis, encephalitis or pneumonias, development of bronchopulmonary pathologies, presence of lymphoproliferative disorders, autoimmunity or malignancy. RESULTS: The mean serum IgG level was significantly higher in group B (308.6±195.9) compared to group A (177.8±151.9; P=0.03). Patients in group B had a significantly higher percentage of CD8 (P=0.003). However, they had lower percentage of CD4 lymphocytes (P=0.08), switched memory B cells (CD27+IgM-IgD-) (P<0.01) and regulatory T cells (P=0.02) than group A.CONCLUSION: Using standard and universal scoring system and understanding of related factors can be applicable in clinical settings for prognosis assessment of CVID patients.

BACKGROUND: The PolyIran study is a large-scale pragmatic cluster randomized controlled trial of fixed-dose combination therapy (Polypill) for prevention of cardiovascular diseases (CVD) in Iran. The PolyIran Quality Control Program (PIQCP) including a new questionnaire was developed to assess the quality of data collection during follow-up visits. The aim of this study was to assess the inter-rater reliability of PIQCP questionnaire.METHODS: The study was conducted in 26 (11%) randomly selected clusters (from a total of 236 PolyIran clusters). All participants within these 26 clusters were enrolled. The quality scores were measured according to the PIQCP guidelines by two independent raters. The intraclass correlation coefficients (ICC) were measured. In addition, the quality scores were categorized into good (370%) and poor (<70%). The kappa coefficient was used to assess inter-rater agreement for this categorical quality scores. RESULTS: A total number of 945 PolyIran participants were enrolled of which, 501 (53%) were from intervention arm. In 934 participants (98.8%), the quality score could be successfully identified by both raters. The ICC (95%CI) of the overall quality scores was 0.985 (0.983-0.987). It was 0.976 (0.972–0.980) and 0.988 (0.986-0.990) in intervention and control arms, respectively. We found excellent agreement between the two raters in identifying participants with good and poor quality scores (kappa =0.988, P<0.001). The kappa values were 0.972 (P<0.001) and 1.000 (P<0.001) in intervention and control arms, respectively.DISCUSSION: Our results suggested that the PIQCP questionnaire is a reliable tool for assessing quality of data collection in PolyIran follow-up visits. Using this measure will help us in efficient monitoring of the PolyIran follow-ups and may ensure high quality data.

BACKGROUND: The emerging goals of journal clubs are now considered to be teaching critical appraisal skills and how to use evidence based medicine in practice. Although journal clubs are well accredited, designing the right format to keep members stimulated and educated remains a great challenge.METHODS: We conducted journal club structure modifications in internal medicine residency program of a university affiliated hospital. Initially, group-based sessions identified feasible changes and baseline data concerning residents' knowledge of evidence based medicine (EBM) was collected using a questionnaire. Modifications were implemented and a second set of group discussions and data collection took place after 12 months.RESULTS: A total of 78 (86.7%) internal medicine residents participated. The most important identified changes were schedule adjustments and setting new goals regarding EBM, medical statistics and critical appraisal teaching. Group discussion showed increased satisfaction and questionnaire assessments showed significant improvement in residents' knowledge of EBM.CONCLUSIONS: Redesigning journal clubs with emphasis on regularity and setting new horizons basically improves their effectiveness. Assigning entire sessions to augment participants 'skills in new areas of knowledge is a unique way to fit journal clubs as a novel and innovative teaching practice.

BACKGROUND/OBJECTIVE: Degeneration of dopaminergic neurons in Parkinson’s disease (PD) implies cell replacement using potentially differentiable sources as a promising therapeutic solution. We tested the capacity of conditioned medium from choroid plexus epithelial cells (CPECs-CM) to induce the dopaminergic potential of umbilical cord matrix mesenchymal stem cells (UCMSCs). METHODS: We isolated UCMSCs from human umbilical cord and CPECs from rat brain. Following expansion and characterization, CPECs-CM were collected, tested for expression of various growth factors, and applied to UCMSCs. Differentiation was examined and UCMSCs were injected into 6-OHDA-leasioned striatum to test their survival and function.RESULTS: RT-PCR and immuno-staining demonstrated neuronal/dopaminergic signaling in UCMSCs induced by CPECs-CM and accelerated by addition of retinoic acid (RA) and fibroblast growth factor-2. Expression of b-tubulin-3, Nestin and MAP2 confirmed neuronal differentiation whereas tyrosine hydroxylase, aromatic acid decarboxylase and dopamine transporter were expressed as signs of dopaminergic differentiation. Post-transplantation, the UCMSCs survived, showed reduced rate of apoptosis and led to animals’ recovery from apomorphine-induced rotations.CONCLUSION: The combination of neurotrophic factors present in CPECs-CM and RA can synergize to maximize dopaminergic differentiation of potential cell sources including UCMSCs. Our study may have implications for PD cell replacement therapy.

BACKGROUND AND OBJECTIVES: This paper aimed to study the epidemiology of suicide and causes related to fatal suicide in Ilam province, west of Iran.METHODS: All data related to attempted suicide and fatal suicide during 2011-2012 were extracted from the suicide registry of authorized directorates in Ilam Province, Iran. Risk factors for fatal suicide were evaluated using logistic regression modeling and discrimination of model assessed using ROC curve.RESULTS: A total of 1537 registered cases were analyzed, among which 130 were recorded as fatal suicides (1227 attempted suicides). Overall, 805 (52.4%) cases were female, 9.2% had a history of suicide, 59.3% were married and 63.3% of cases were aged under 24 years. The most common suicide method was overdose of medications (75.5%). In multivariable analysis, male gender (OR: 0.50; CI 95% 0.25 to 0.99) and higher education (OR: 0.36; CI 95% 0.20 to 0.65) were protective factors and application of physical methods (OR: 11.61; 95% CI 5.40 to 24.95) was a risk factor for fatal suicide.CONCLUSIONS: Female gender, low education level and use of physical methods of suicide were revealed as risk factors of fatal suicide. We suggest population based case-control studies based on the suicide registry data for further assessing the risk factors of suicide in Ilam.

BACKGROUND: Recent studies have shown that metabolic syndrome is associated with poor health-related quality of life (HRQoL). Moreover, it is shown that the prevalence of MetS and impaired glucose regulation, which are shown to have negative impact on HRQoL, overlap. This study aimed to investigate the association between HRQoL and metabolic syndrome (MetS) considering glucose regulation status in a sample of non-diabetic Tehranian adults.METHODS: This was a cross-sectional study conducted within the framework of the Tehran Lipid and Glucose Study (TLGS).Logistic regression analysis was used to estimate the odds ratio (OR) with 95% confidence interval (CIs) in normal and impaired glucose regulation. Cochran’s Mantel-Haenszel test was used to test the homogeneity of the odds ratios for reporting poor HRQoL in those with MetS in two groups of normal and impaired glucose regulation.RESULTS: Totally, 946 participants were studied. After adjustment for age and educational level in women, MetS showed a significant negative impact on physical functioning and bodily pain in those with impaired glucose regulation and physical role limitation in normal glucose regulation group. In impaired glucose regulation group, women with MetS were more likely to report poor physical functioning (OR: 2.86, CI: 1.02-2.79), and bodily pain (OR: 2.96 CI: 1.09-8.04). In women with normal glucose regulation, poor physical role limitation was significantly associated with MetS. This association was not seen in men in either group. Based on the test of homogeneity of odds ratio, the association between MetS and HRQoL in those with normal and impaired glucose regulation was different in role physical subscale.CONCLUSIONS: The current study showed that in both normal and impaired glucose regulation groups, MetS was associated with poor physical HRQoL in women but not men.

Bone marrow mesenchymal stem cells (BM-MSCs) are commonly known as nonhematopoietic-nonendothelial cells based on in vitro expressed markers and properties. Despite the massive research on ex vivo expanded MSCs, their in vivo identity remains elusive. In this study, we report the existence of large multinuclear CD31 positive cells in the beginning of human BM-MSCs culture. Interestingly, the adjacent multinuclear cells occasionally formed tube-like structures. The large multinuclear cells then gave rise to mononuclear cells that fulfilled the criteria for BM-MSCs and were negative for CD31 but positive for other endothelial markers, CD54, CD106, and CD144. These observations, although primitive, imply that MSC ancestors may directly participate in the formation of new vessels. Further studies on BM-MSCs in the first few days of culture are definitely required to investigate the exact role of these cells in the vascular system.

BACKGROUND: Several studies have investigated the effect of Co-Q10 on diabetes biomarkers, but findings are inconsistent. This systematic review and meta-analysis of clinical trials was conducted to summarize the effect of Co-Q10 supplementation on diabetes biomarkers.METHODS: We searched Pubmed, EMBASE, Science direct, ISI web of science, and Google Scholar for randomized controlled trials from 1989 until March 2016. We included randomized controlled trials reporting fasting blood glucose (FBG), fasting insulin and HbA1c. In total, we found 16 articles that examined the effect of Co-Q10 on fasting blood glucose, fasting insulin and HbA1c. Mean ± standard deviations (SD) of defined outcomes were used for calculating standardized mean differences (SMD) and its 95% confidence interval (95%CI) between intervention and control treatments based on Hedges’ estimator. RESULTS: Our preliminary meta-analysis on 14 eligible studies regarding the effect of Co-Q10 supplementation on FBG indicated a slightly significant decrement (SMD:-0.28 mg/d; 95% CI: -0.12, 0.04), with a substantial between-study heterogeneity (Cochrane Q test, I2=93.9%, P<0.0001). After removal of three studies, heterogeneity was eliminated and a slightly significant decrease was found in FBG (SMD: -0.20 mg/dL, 95% CI: -0.38, -0.02). The effect of Co-Q10 on HbA1c and fasting insulin was not significant. SMDs for the effect of Co-Q10 on HbA1c and fasting insulin were -0.05% (95% CI: -0.22, 0.12) and 0.12 pmol/L (95% CI: -0.21, 0.44), respectively. CONCLUSION: Co-Q10 supplementation slightly but significantly reduced fasting blood glucose, but not fasting insulin and HbA1c. More long-term studies are necessary to examine the association between Co-Q10 supplementation and diabetes biomarkers.This study was funded by the School of Nutrition and Food Science, Isfahan University of Medical Sciences.

Vitamin D is a pro-hormone that plays an important role in body calcium regulation. Vitamin D toxicity occurs rarely due to its wide therapeutic index. A 38-year-old Iranian man was admitted to our hospital with a diagnosis of vitamin D toxicity. Laboratory test revealed hypercalcemia and elevated 25-hydroxyvitamin D (25(OH)D) level. Despite the cessation of vitamin D intake and diuretic treatment, he presented four months later with high 25(OH)D level and similar clinical features. Due to the potential release of vitamin D from adipose tissue, serial monitoring of 25(OH)D level is recommended.

Parasites and parasitic diseases have been prevalent in Iran according to Iranian ancient scholars and physicians’ inscriptions dating back to 865–1496. Some protozoan diseases such as malaria and cutaneous leishmaniasis have been introduced by clinical manifestations and helminthic infections by size and morphology of the worms. Scientific studies of Parasitology started in Iran from 1833, first by foreign physicians and continued from 1909 by Iranian researchers. The pioneer medical parasitologists of Iran were Dr N. Ansari and Dr. Sh. Mofidi who established the Department of Medical Parasitology in the School of Medicine, University of Tehran, 1939. Afterward, a considerable number of researchers and professors of parasitology have been active in training and research works in the fields of medical parasitology throughout the entire nation. At present, some significant parasitic diseases such as bilharsiasis and dracunculiasis are more or less eradicated and malaria is in the elimination phase. The prevalence of most helminthic infections has considerably decreased. Most of the departments of medical Parasitology in Iran are active in training MD, MSPH and PhD students. The Iranian Society of Parasitology established in 1994 is active with many eligible members and its creditable publication, the Iranian Journal of Parasitology, published seasonally since 2006. From 1833, when the scientific studies of Parasitology have started in Iran up to 2013, many researchers have been done on various fields of medical Parasitology and parasitic diseases in Iran and 2517 papers in English and 1890 papers in Persian have been published in national and international scientific journals. In addition, more than 420 books related in the field of medical parasitology field have been published in Persian language.

In their article, Dr. Janani et al. discussed some methods to obtain adjusted risk ratio (RR).1 Among options, authors mentioned the method named “expanded logistic regression”, which consists in changing the original dataset by duplicating data of each individual that developed the outcome. ...

Dear Editor;With advances in technology, the way we learn has changed dramatically in recent years. Nowadays, many online courses are available over the Internet with the aim of providing quality education for all the people across the globe. But, recently when I was trying to register for a free online course offered by the Stanford University through Stanford’s online learning initiative on interpreting randomized clinical trials, I realized that I cannot sign up for the course.