ARCHIVES OF IRANIAN MEDICINE
Year:2018 | Volume:21 | Issue:8|Papers Count:10

Background: Afghanistan is one of the low-income countries in the Eastern Mediterranean Region with young population and myriad of healthcare needs. We aim to report the burden of diseases and injuries in Afghanistan between 1990 and 2016. Methods: We used the Global Burden of Disease (GBD) 2016 study for estimates of deaths, disability-adjusted life years (DALYs), years of life lost, years of life lived with disability, maternal mortality ratio (MMR), neonatal mortality rates (NMRs) and under 5 mortality rates (U5MR) in Afghanistan. Results: Total mortality rate, NMR and U5MR have progressively decreased between 1990 and 2016. Mortality rate was 909. 6 per 100 000 (95% UI: 800. 9– 1023. 3) and MMR was 442. 8 (95% UI: 328. 3– 595. 8) per 100 000 live births in 2016. Conflict and terrorism, ischemic heart disease (IHD) and road injuries were the leading causes of DALY among males of all ages in 2016 with 10. 9%, 7. 8% and 7. 6% of total DALYs respectively, whereas among females of all ages lower respiratory infections (LRIs), IHD and congenital birth defects were the leading causes of DALY with 8. 7%, 7. 0% and 6. 5% of total DALYs respectively. Conclusion: Despite improvements in certain health indicators, our study suggests an urgent intervention to improve health status of the country. Peace and safety by means of stopping the conflict and terrorism are the mainstay of all other health interventions. Improving health infrastructures, boosting maternal and child health (MCH), battling infectious diseases as well as chronic disease risk factor modification programs can help to decrease burden of diseases.

Background: High blood pressure is an important risk factor for all-cause mortality and cardiovascular mortality and morbidity among Iranians. We aimed to estimate its prevalence, correlates, and its rate of awareness, treatment, and control in South of Iran. Methods: The Pars Cohort Study (PCS) was launched in a district of Fars province. All residents between 40 and 75 years old in the district were recruited from 2012 to 2014. Hypertension was defined as either systolic/diastolic blood pressure ≥ 140/90 mm Hg or taking medications. Logistic regression was used to identify the correlates of hypertension and awareness and its treatment and control. A total of 9264 participants were recruited. Of the total participants, 46. 2% were men. The mean age was 52. 6 years (SD: 9. 7). Results: Prevalence of hypertension was 26. 9%. Of the total 2489 hypertensives, 49. 6% were aware and 55. 7% were under treatment. Blood pressure was controlled in 69. 2% of treated hypertensives. In the adjusted model, female sex and history of cardiovascular disease (CVD) were positively associated with having hypertension, higher awareness, and better treatment and control. Older age, being overweight or obese, and having a history of diabetes were also positively associated with having hypertension and higher awareness and treatment; however, being overweight or obese was associated with poorer hypertension control. Older age and having a history of diabetes did not show a statistically significant association with control. Conclusion: Being underweight and higher physical activity were inversely associated with having hypertension but were not associated with awareness, treatment, or control. Prevalence of hypertension is high but the rates of awareness, treatment, and control are not adequate.

Background: We aimed to recognize the predictors of long-term major adverse cardiac events (MACE) in the elderly candidates for elective percutaneous coronary intervention (PCI) at our center. Methods: In this retrospective cohort study, we reviewed the data of the elderly (age ≥ 65 years) candidates for elective PCI who met our study criteria, at Tehran heart center between 2004 and 2013. Demographic, anthropometric, clinical, angiographic, procedural and follow-up data of the enrolled patients were retrieved from the angiography/PCI databank of our center. The study characteristics of the patients with or without MACE were compared in a univariable Cox-regression analysis. A multivariable Cox-regression model was applied using variables selected from the univariable model to determine the predictors of MACE. Results: We reviewed the data of 2772 patients (mean age = 70. 8± 4. 7 years, male sex=1726 patients [62. 3%]) from which 393 patients (14. 4%) developed MACE. In the multivariable regression model, female sex was a protective factor for MACE (hazard ratio [HR] = 0. 701; P = 0. 001), while presence of diabetes mellitus (HR = 1. 333; P=0. 007), family history of coronary artery disease (CAD) (HR = 1. 489; P = 0. 003) and plain balloon angioplasty (HR = 1. 810; P = 0. 010) were independent risk factors for MACE. Conclusion: PCI is a safe and effective method of revascularization in the elderly patients, and some clinical and procedural factors can predict MACE in this group of patients.

Background: Vancomycin is widely used for infections caused by gram-positive bacteria, but little attention has been paid to vancomycin in the treatment of critically ill patients aged ≥ 80 years. The aim of the current study was to investigate the efficacy of vancomycin and risk factors associated with nephrotoxicity of vancomycin in elderly critically ill patients. Methods: A retrospective study was performed in a 14-bed medical-surgical geriatric ICU between January 2007 and June 2014. The patients (aged ≥ 80 years) were included if they received ≥ 4 doses of vancomycin and the therapy duration was ≥ 2 hours. Results: The clinical efficacy was 74. 0% (37/50). The 28-day mortality was 26. 0% (13/50). Of the patients, 24% (12/50) had nephrotoxicity during vancomycin treatment period. The clinical efficacy was 60%, 86. 7%, 58. 3%, and 33. 3%, and the 28-day mortality rate was 20%, 23. 3%, 33. 3%, and 33. 3%, respectively, when the trough concentrations were ≤ 10 μ g/mL, 10– 15 μ g/mL, 15– 20 μ g/mL, and ≥ 20 μ g/mL. The multivariate logistic regression analysis showed that an Acute Physiology and Chronic Health Evaluation (APACHE) II score ≥ 25 points, vancomycin trough concentrations ≥ 15 μ g/mL, and the combined use of diuretics (furosemide ≥ 40 mg/d) were independent risk factors leading to nephrotoxicity. Conclusion: We did not find that higher vancomycin trough concentrations lead to better clinical outcomes in elderly critically ill patients. Increased vancomycin trough concentrations, high APACHE II scores, and the combined use of diuretics may increase the risks of nephrotoxicity in elderly critically ill patients.

Background: The theory if self-efficacy is the central concept of social cognitive theory with emphasis on the constructs of efficacy expectation, outcome expectation. Efficacy expectation is defined as the person’ s confidence to carry out a specific behavior. Outcome expectation is beliefs that carrying out a specific behavior will lead to a specific outcome. While the benefit of measuring outcome expectations has been established, there has been no large scale within the Iranian context. The purpose of this study is to examine the reliability-validity of the Persian version of the Perceived Therapeutic Efficacy Scale (PTES). Methods: This study was conducted among 160 patients with type 2 diabetes mellitus (T2DM) using a self-administered instrument measuring outcome expectation. We used a methodological study design to assess the validity and reliability of the translated Persian version of the instrument. Results: The findings of the present study support the uni-dimensionality of the Persian version of the instrument. The 10 items of the scale account for 73. 54% of the total variance and the un-rotated factor loadings ranged from 0. 66 to 0. 93. Moreover, this study offers support for convergent validity and internal consistency of the scale. Conclusion: Our study demonstrated good convergent validity, factor structure and internal consistency in a sample of 160 Iranian adults with T2DM. Therefore, the Persian version of the scale is a valid and reliable instrument and can be used in research and clinical settings.

Background: The mesenchymal stem cells (MSCs) of peripheral blood (PB) have been recognized as a promising source for allogeneic cell therapy. The objective of the present study was to isolate and characterize MSCs derived from non-mobilized PB, and evaluate their differentiation potential. Methods: The buffy coat mononuclear fractions of the PB were concentrated using the Ficoll-Paque density gradient centrifugation and were grown on primary and secondary culture media, respectively. The isolated cells were characterized using a multidisciplinary approach which was based on morphology, immunophenotyping, gene expression, and multipotentiality. Flow cytometry and Reverse transcription polymerase chain reaction (RT-PCR) were used to identify the expression of different MSC markers. Finally, after culturing in osteogenic and adipogenic induction media, the isolated cells were stained by Alizarin red and Oil-Red O. Results: In spite of absence of any bone marrow stimulating factor, the isolation approach in this study yielded a rather homogeneous and spindle-shaped mononuclear cell population (the yield of passage 0 was 0. 65 ± 0. 15) that stained positive for CD90, CD105, and CD73, and were negative for CD45 and CD34. These cells have high proliferative capacity (confirmed by the expression of Oct-4, Nucleostemin, and Nanog genes) and were able to differentiate into lineage-specific committed cells, when exposed to the appropriate medium. Conclusions: Overall, it can be concluded that conventional, labour-intensive and time-consuming approaches are not necessary in isolating MSCs from PB. This relatively accessible and minimally invasive source, PB, represents a good alternative reservoir of homogeneous MSCs that could open a new era for practical exploitation in regenerative medicine.

Randomized clinical trials are considered the ideal source for generation of robust evidence for clinical and public health decision making. Estimation of treatment effect in observational studies is always subject to varying degrees of bias due to lack of random allocation, blindness, precise definition of intervention, as well as the existence of potential unknown and unmeasured confounding variables. Unlike other conventional methods, instrumental variable analysis (IVA), as a method for controlling confounding bias in non-randomized studies, attempts to estimate the treatment effect with the least bias even without knowing and measuring the potential confounders in the causal pathway. In this paper, after understanding the main concepts of this approach, it has been attempted to provide a method for analyzing and reporting the IVA for clinical researchers through a simplified example. The data used in this paper is derived from the clinical data of the follow-up of multiple sclerosis (MS) patients treated with two class of interferon.

Many reported scientific misconducts included duplication, data fabrication and falsification; but recent fake peer reviews have become strange news for many researchers worldwide. Using gmail and other non-academic emails to correspond with journals should be highly prohibited. Indeed, the dark part of this story is lack of conscience by editors who run some journals. Our suggestion in this paper can decrease the chance of repeating similar retractions in close future.

A 14-year-old girl presented to the emergency department with unilateral neck swelling, odynophagia, and dysphagia since last week.

In 2018, the memoirs of Dr. Moslem Bahadori (b. 1927), the pioneering professor of pathology at the TehranSchool of Medicine was published