ARCHIVES OF IRANIAN MEDICINE
Year:2018 | Volume:21 | Issue:7|Papers Count:8

Background: Iran’ s experience with liver transplantation (LT) began more than two decades ago. The purpose of this article is to present the status of LT in Iran, review specific characteristics of the programs, their outcomes, and their growth to become one of the largest LT programs in the world. Methods: A questionnaire, asking for data on the number of transplants performed and specifics of the recipients and type of donors with focus on indications and outcomes was sent to LT programs. Results: During a period of 23 years, 4, 485 LTs were performed at 6 centers in the country. Of these, 4106 were from deceased donors and 379 were from living donors. There were 3553 adults and 932 pediatric recipients. Hepatitis B and biliary atresia were the most common etiologies in adult and pediatric patients, respectively. Overall survival rates at 1, 5, and 10 years were 85%, 77%, and 71% for adults and 76%, 67% and 56% for pediatric patients, respectively. Conclusion: Approval of the brain death law in Iran and coordinated efforts by the transplant centers to build comprehensive LT programs has resulted in the ability to procure more than 700 deceased donors per year with acceptable long-term survival.

Background: Helicobacter pylori might become highly resistant to antibiotics taken through the life time of patients. This study examined the change in antibiotic resistance of H. pylori by time. Methods: Out of 985 dyspeptic patients who were referred to the endoscopy unit of Shariati hospital during 2010-2017, 218 patients with gastric biopsies positive for rapid urease test (RUT) and H. pylori culture were recruited in the study. H. pylori isolates were examined for resistance to 8 currently used antibiotics by the disc diffusion method. Results were compared with those from our three previous studies. The frequency of multidrug resistance (MDR) was also assessed. Results: The highest resistance rate was to metronidazole (MTZ) (79. 4%) followed by ofloxacin (OFX) (58. 7%), ciprofloxacin (CIP) (46. 8%), levofloxacin (LVX) (45%), tetracycline (TET) (38. 5%), clarithromycin (CLR) (34. 4%), amoxicillin (AMX) (27. 1%) and furazolidone (FRZ) (23. 9%). No significant difference was found between resistance of H. pylori isolates from male and female <40 and >40 years old and patients with gastritis and peptic ulcer. The highest rates of MDR were to MTZ+OFX (4. 6%), MTZ+OFX+TET (2. 8%), MTZ+OFX+CIP+LVX (6. 4%) and MTZ+OFX+TET+ CIP+LVX (5%). Conclusion: Resistance to MTZ increased from 33%– 55. 6% in previous studies to 79. 4% by time, to CLR increased from 1. 4– 7. 3% to 34. 4%, to TET increased from 0– 38. 1% to 38. 5%, to AMX increased from 1. 4%– 7. 3% to 27. 1% and to FRZ increased from 0%– 4. 5% to 23. 9%. Resistance to FQs was 45%– 58. 7%. Increase in H. pylori antibiotic resistance indicates antibiotic misuse. In Iran, with a considerable number of H. pylori-infected patients, antibiotic therapy should be saved for high risk patients and according to local antibiotic resistance patterns.

Background: This study was conducted to evaluate the effects of probiotic supplementation on gene expression related to inflammation, insulin and lipid in patients with Parkinson’ s disease (PD). Methods: This randomized, double-blind, placebo-controlled clinical trial was conducted in 50 patients with PD as a pilot study. Participants were randomly allocated into two groups to take either 8×109 CFU/day probiotic supplements or placebo (n = 25 each group, one capsule daily) for 12 weeks. Gene expression related to inflammation, insulin, and lipid was quantified in peripheral blood mononuclear cells (PBMC) of PD patients, with RT-PCR method. Results: After the 12-week intervention, compared with the placebo, probiotic intake downregulated gene expression of interleukin-1 (IL-1) (P = 0. 03), IL-8 (P < 0. 001) and tumor necrosis factor alpha (TNF-α ) (P=0. 04) in PBMC of subjects with PD. In addition, probiotic supplementation upregulated transforming growth factor beta (TGF-β ) (P = 0. 02) and peroxisome proliferator-activated receptor gamma (PPAR-γ ) (P = 0. 03) in PBMC of subjects with PD compared with the placebo. We did not observe any significant effect of probiotic intake on gene expression of low-density lipoprotein receptor (LDLR) and vascular endothelial growth factor (VEGF) in PBMC of patients with PD. Conclusion: Overall, probiotics supplementation for 12 weeks in PD patients significantly improved gene expression of IL-1, IL-8, TNF-α , TGF-β and PPAR-γ , but did not affect gene expression of VEGF and LDLR, and biomarkers of inflammation and oxidative stress.

Background: Leukocyte adhesion deficiency type 1 (LAD1) is an autosomal recessive disorder caused by reduced expression or function of CD18. It was well accepted that LAD1 resulted from mutations in the gene for the integrin β 2 subunit. Methods: We reported a moderate LAD1 patient with 2 novel ITGB2 mutations, and further investigated the role of the 2 mutations on the expression and function of CD18 by gene transfection. Results: The 2 novel mutations included a frameshift deletion viz c. 954G del, which was considered as a major pathogenic gene for the patient, and a missense mutation viz c. 1802C>A (Cys601Phe), which caused a damaging effect on the ITGB2 protein. There was no significant difference in protein expression between 293 T cells with mutant ITGB2 p. 601C>F and 293 T cells with wild type ITGB2. When investigating the cellular location of the mutant ITGB2 in HeLa cells, we found that the mutant ITGB2 (p. 601C>F) protein could not locate to the cell membrane. This indicated that the mutant ITGB2 protein could not perform its function at cell membrane level. Conclusion: The 2 novel ITGB2 mutations affected the expression and function of CD18 and might be pathogenic genes for LAD1.

Background: Malnutrition in hospitalized patients causes problems in treatment and increases hospitalization duration. The aim of this research was to determine the prevalence of malnutrition in hospitalized children. Methods: Children aged 1 month to 18 years (n = 1186) who were admitted to medical and surgery wards of Mofid children’ s hospital from November 2015 to February 2016, entered the study. We measured different anthropometric variables in patients with malnutrition. Also, nutritional counseling was performed and three months follow-up was done. Results: Patient data were registered in questionnaires particularly for children 2 years old and less. 597 children under 2 years of age and 607 children over two years entered the study. The data analysis was done by SPSS version 22. 0 (Chicago, IL, USA). The t test inferential method was used in comparing variables. P values less than 0. 05 were considered statistically significant. Based on the body mass index (BMI) Z score, and in accordance with the World Health Organization (WHO) cut-off, among children over 2 years, 9% were diagnosed as overweight or obese, 54% were within the normal range and 37% were underweight at time of admission. In the underweight group, 43% were mildly, 21. 2% were moderately and 35. 8% were severely underweight. Based on the weight for length Z score in patients less than 2 years of age at time of admission, 6% were overweight, 60% were in normal range and 34% were underweight. Among children with malnutrition, 21% had mild, 3. 0% had moderate and 10% had severe malnutrition. No significant meaningful relation was found between prevalence of malnutrition and severity of illness. In the moderate to severe undernutrition group, nutritionist counseling was done. Comparison of BMI and weight, before and after admission (the baseline and the follow up visits), was done by means of repeated measurements. Comparison of the patient’ s weight at time of admission with weight at 1, 2 and 3 months after the first nutritional consultation showed statistically meaningful difference (P value < 0. 05). Conclusion: Growth indices need to be evaluated in every hospitalized child. Nutritional consultation is useful in children with malnutrition. The main purpose of early diagnosis of malnutrition is to prevent its progression, and also to design a useful, applicable and cost-effective nutritional intervention for malnutrition treatment.

The patient was a 32 years old non-smoker, non-alcohol user man who presented to Shahid Motahari Clinic of Namazi Hospital with cough and fever and right side pleuritic chest pain since 3 weeks ago with gradual onset and progressive in nature, that with recognition of pneumonia received antibiotic therapy but his condition did not improve. . . .

IntroductionVarious parts of plants, including seeds, berries, roots, leaves, bark or flowers have been used for medicinal purposes from prehistoric times throughout the world. In recorded history, herbal medications are mentioned in Egyptian papyri, traditional Chinese and Indian Ayurvedic as well as ancient Iranian Avestan texts. ...

The recent efforts for revitalizing traditional Iranian medicine (TIM) have shaped two main streams: The quackery traditional iranian medicine (QTIM) and the academic traditional iranian medicine (ATIM). The QTIM encompasses a wide range of practitioners with various backgrounds who work outside the academic arena and mostly address the public. These practitioners have no solid bases or limited boundaries for their claims. Instead, they rely on making misleading references to the Holy Islamic Scriptures, inducing false hope, claiming miraculous results, appealing to the conspiracy theories, and taking advantage of the public resentment toward some groups of unprofessional healthcare providers. The theories and practices of ATIM, however, can be categorized into two major categories: First, valid and scientific TIM that is aimed to conduct well-designed clinical trials and thereby, supply the evidence-based medicine with new treatments originated in or inspired by TIM. Second, a pseudoscientific part of the current TIM that is based on some obsolete medical theories, especially the medieval humoral medicine, and erroneous accounts of human anatomy, physiology, and physiopathology, mostly adopted from the ancient and medieval medical scripts. TIM has recently established some clinical centers for practicing humoral medicine that is partly pseudoscientific and involves significant risks. This paper suggests that the public health sector has a duty to act against the promulgation of medical superstitions by QTIM and the pseudoscientific medical practices of ATIM, and at the same time, support and promote the valid and potentially beneficial research pursued by ATIM aimed to explore the rich recourses of TIM and thereby enrich the evidence-based medicine.