ARCHIVES OF IRANIAN MEDICINE
Year:2019 | Volume:22 | Issue:5|Papers Count:12

Background: This study aimed to investigate the epidemiology of psychiatric disorders in children and adolescents in Chaharmahal and Bakhtiari Province of Iran. Methods: This community-based cross-sectional study included 1038 children and adolescents aged 6-18 years from Chaharmahal and Bakhtiari province selected by the multistage cluster sampling method. Samples were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Also, demographic data (gender, age, child education, parent education, and economic situation) were obtained. Binary logistic regression was used to analyze the data. Results: A total of 16. 1% of participants were diagnosed to have psychiatric disorders. Total psychiatric disorders were significantly more prevalent in boys than in girls (P = 0. 025). Unemployment of fathers was significantly related to increased prevalence of psychiatric disorders in children (P = 0. 016). Other demographic variables had no significant correlation with prevalence of psychiatric disorders in children. Anxiety disorders were highly comorbid with behavioral problems (16. 4%). Behavioral disorders also had high comorbidity with elimination disorders (16. 7%) and substance use disorders (10%). Enuresis was the most frequent psychiatric disorder (5. 8%), followed by epilepsy (3. 5%), tobacco use (3. 4%), and attention deficit hyperactivity disorder (3%). Total anxiety disorders were the most prevalent group of psychiatric disorders in the sample (21. 9%), followed by behavioral disorders (16. 3%), elimination disorders (8. 2%), and neurodevelopmental disorders (4. 5%). Conclusion: Our findings suggest that psychiatric disorders affect a significant number of children and adolescents. Prevalence estimates and identification of sources of heterogeneity have important implications to service providers and modifications are needed in mental health services in the community.

Background: Intravenous immunoglobulin (IVIG) is an immunomodulating agent that has several actions. The aim of this study was to investigate the indications of IVIG according to available evidence and the cost in our center. Methods: This retrospective study was conducted between September 2017 and June 2018 at a teaching hospital affiliated with Iran University of Medical Sciences, Tehran, Iran. Patients’ demographic data and disease, indication for IVIG use, its dosage and treatment regimen and previous and concurrent treatments were assessed. The collected data were compared with the present criteria for the pattern of IVIG usage. The last version of Lexicomp® was used as the reference for indications of the administrated drug and its dosage. Results: A total of 119 patients received IVIG during the study period. The wards with the most frequent IVIG prescription were the neurology (46. 2%) and neonatal intensive care unit (21%). The most common reasons of IVIG therapy were various inflammatory neurological disorders. IVIG was used in 22, 43 and 54 cases according to on-label, off-label and other indications, respectively. The total price was higher for off-label indications for IVIG ($254 343. 75) than on-label indications ($152 625). As well, $107 250 was exhausted for cases in which there was not sufficient evidence. Conclusion: One important aspects of this study was the use of IVIG in cases other than on-label indications. Although a number of studies support IVIG therapy in some diseases, further trials are needed to establish efficacy and safety in these fields.

Background: Aging is significantly related to multiple comorbidities. Even with a good performance score, some elderly patients may have poor survival outcomes. We aimed to evaluate the prognostic value of the Charlson comorbidity index (CCI) for mortality and toxicity in elderly patients with locally advanced rectal cancer (LARC). Methods: Seventy-two elderly patients with LARC who were treated with neoadjuvant chemoradiotherapy (CRT) were included. Based on their CCI score, severity of the comorbidity was categorized into 2 groups: CCI<7 and CCI≥ 7. Results: The overall survival (OS) at 5 years was 54. 4 percent in patients treated with neoadjuvant CRT. Median OS was not reached for all patients as well as patients with CCI score <7, but median OS was 25 (95% CI 1. 0– 62. 1) months in patients with CCI≥ 7 (P = 0. 002). The OS at 2 years was 79. 1 percent in the patients with CCI <7 and 50. 0 percent in the patients with CCI score ≥ 7 (P = 0. 002). Moreover, there was a trend toward, patients with higher CCI score who had more treatment related to grade 3 or 4 toxicity compared to those with CCI score <7 (33. 3% vs 13. 3%, respectively, P = 0. 09). Multivariable analysis indicated that the CCI score ≥ 7, presence of down-staging after therapy and clinical stage (III) independently predict mortality (HR 6. 14, 95%CI 2. 45– 15. 35, P < 0. 001) in patients with LARC. Conclusion: Although CCI score was not significantly associated with both toxicity and disease-free survival (DFS), we suggest that baseline CCI score might be a valuable prognostic indicator for physicians to evaluate elderly patiens with LARC for optimal treatment.

Background: Aichi virus (AiV) is an emerging virus, which belongs to Kobuvirus genus of the Picornaviridae family. AiV was recently determined as an etiologic agent of gastroenteritis in susceptible humans. After shedding of virus particles from affected people, AiV particles can contaminate water sources. Then, infection with this virus occurs in humans by the fecal-oral route after exposure with contaminated waters. Thus far, some research around the world demonstrated that different kinds of water sources including river water, ground water and treated or untreated sewage water have contamination with AiVs. Molecular detection of AiV has been mostly depended on reverse transcription polymerase chain reaction (RT-PCR) methods, which targeted 3CD junction region of the virus genome. Methods: The present study aims to assess the molecular detection of AiVs in treated and untreated sewage water and river water specimens by the development of reverse transcription-quantitative PCR (RT-qPCR) assay for all AiV genotypes. Results: Out of 50 samples tested (consisting of 28 river water samples and 22 sewage water samples), the AiV genomic RNA was identified in 15/28 (~50%) river water samples and in 14/22 (~70%) sewage samples. Conclusion: Our results, for the first time, indicate that AiVs have been circulating in Iran.

Background: We aimed to identify the association of degree of renal failure in chronic kidney disease patients who underwent percutaneous coronary intervention (PCI) at our center with 5-year major adverse cardiac events (MACE). Methods: In this cohort study, we enrolled all patients who underwent primary or elective PCI and completed their 5-year follow-up unless they developed events related to study end-points. Demographic, angiographic and clinical data of the participants were retrieved from our databank. Glomerular filtration rate (GFR) was calculated based on the Cockcroft-Gault equation for men and women, separately. Accordingly, our patients were classified into three groups: GFR ≥ 60, GFR < 60 and ≥ 30 and GFR < 30 mL/min. Then, the demographic and clinical data, as well as the frequency of MACE and its elements, were compared between the study groups. Results: We included the data for 5, 510 patients. MACE occurred in 891 (16. 1%) of the patients. A total of 632 cases (16. 7%) occurred in patients with GFR > 60 while 224 cases (18. 8%) and 35 events (43. 7%) occurred in patients with 30 ≤ GFR < 60 and GFR < 30 mL/min, respectively. So, GFR < 30 mL/min was significant predictor for MACE (hazard ratio [HR] = 3. 74, 95% CI: 2. 64– 5. 28; P < 0. 001). The prediction effect of GFR < 30 remained significant after adjustment for the confounding variables (HR = 3. 43, 95% CI: 2. 38– 4. 94; P < 0. 001). Conclusion: GFR <30 mL/min was a strong predictor for 5-year MACE. Moreover, in patients with GFR > 30 mL/min, PCI is a more applicable approach.

Background: Incidental findings are presented in radiology reports. Many of these findings do not require further investigation; however, some require further investigation and repeated imaging. The aim of this study was to determine the frequency of incidental findings on CT scans of patients with head trauma from 2005 to 2015. Methods: This analytical cross-sectional study was conducted in years on 5, 193 CT scan reports referred to Shahid Rahnemoun hospital in Yazd, Iran. The images were evaluated by consensus agreement of two radiologists. The relationship between age, sex and incidental findings was analyzed using the SPSS 20 software. Results: A total of 5, 193 subjects with a mean age of 34. 16 ± 21. 17 were examined. About 64% of cases were male. The frequency of incidental findings was 10. 9%. The most common finding was calcification with a frequency of 3. 3% and the least was Dandy Walker finding at 0. 02%. There was no relationship between age, sex and the frequency of incidental findings. No significant trend was found between IFs frequency during ten years. Conclusion: The results of this study indicated that most incidental findings were related to benign findings, but also malignant findings were diagnosed.

Background: Studies have reported contradictory findings regarding the effect of a mixture of 2 conjugated linoleic acid (CLA) isomers on body weight and some serum indices. This study aims to investigate the effect of daily supplementation of these 2 isomers on body composition and serum leptin and insulin levels in obese adults. Methods: This randomized, double-blind clinical trial was performed on 54 adults with class I obesity. The subjects were randomly assigned into 2 groups of 27 and were followed for 3 months so that a total of 3000 mg of CLA supplement and placebo were administered in 3 daily doses in the intervention and control groups, respectively. Body composition indices as well as fasting serum levels of insulin and leptin were also measured. The paired t-test was used for evaluating within-group effects from baseline. The independent t-test was used to compare between-group differences for variables with normal distribution. Results: Although body weight and body mass index (BMI) were not significantly decreased during intervention in groups, but the body fat mass (BFM) (P = 0. 034), body fat percentage (P = 0. 022) and trunk fat (P = 0. 027) decreased significantly during intervention with CLA. The fasting plasma sugar (P = 0. 042) and Homeostatic model assessment for insulin resistance (HOMA/IR) (P = 0. 044) in the intervention group declined during 12 weeks of intervention. Serum leptin was associated with a significant decrease during the intervention period (P = 0. 039). Conclusion: CLA supplementation could reduce body fat and serum leptin. Hence, it could be taken into account as a factor for weight loss but not to control or prevent diabetes.

Despite all the problems caused by the imposed war, sanctions and accidents after the Islamic Revolution, materializing primary health care (PHC) in Iran through establishing the National Health Network (NHN) has had substantial gains. Many health indicators in Iran have undergone significant changes. As an example, the change in death of children under the age of 5 years has been studied by adjusting the economic status, and it is estimated that about 2 million deaths in this age group were avoided within 30 years after the Islamic Revolution. Nevertheless, the global experience implies that the PHC has its limitations. By changing the social, economic, and epidemiological patterns of diseases, demands and expectations of community has changed. With the emergence of chronic conditions and new technologies, health expenditures have become a major concern. Meanwhile, in the 2000s, the revision at PHC was aimed at strengthening through the universal health coverage (UHC). Therefore, UHC is along the PHC and not against it.

Treatment of hairy cell leukemia (HCL) with alfa-interferon and purine analogs significantly prolongs survival in these patients. However, with life prolongation, an increased risk of secondary malignancies has been reported. Acute myeloid leukemia (AML), as a second malignancy after HCL treatment is extremely rare and has been reported in only 12 cases so far. We here report additional 2 cases of CD56+ AML developed after sustained clinical remission of HCL achieved with cladribine (2 and 6 years after, respectively). The first patient refused chemotherapy and shortly thereafter died. The second patient responded to chemotherapy and was successfully allo-transplanted. Three years later, the patient is in stable clinical remission, which is a unique case in the literature. In conclusion, it is not clear whether development of AML in HCL patients is caused by mutagenic potential of the applied chemotherapy or by immune suppression/ perturbations as a characteristic of the underlying disease.

Dr Malekafzali, an elite biostatistics professor at Tehran University of Medical Sciences, in his more than 50 years of glorious service, has played a crucial role in creation of fundamental evolution in public health, reproductive health and development of applied research in Iran. He has left lasting activities in administrative positions such as health and research deputies, health minister consultant, director of health faculty and director of health research institutes. He published several books and articles on statistics, epidemiology and public health. This article is a review of his worthy and interesting activities in the country’ s health, research and education.

Dear Editor, Rashidian and colleagues have published an interesting study entitled, “ Which Social Values Are Considered in Iranian Health System? ” 1 Although concept of social values was the heart of the study, lack of clear definition of value and of the criteria brought some challenges in understanding of the participants about social values regarding priority setting of the health system, in interpreting of the findings and even generalization of the results to real world policy making in the health system of Iran. According to the Table 1, there are some differences between value and criteria which must be taken to account in deriving social values regarding priority setting in the health system. 2-4...

Dear Editor, We read the comments of our dear reader1 about our article entitled, “ Which social values are considered in Iranian health system? 2 ” We want to thank the reader for his valuable notes, and we want to explain some points about the paper: Health systems provide health services to meet the needs of a population through limited resources. This limitation makes it necessary to set priority and allocate resources based on both ethical and technical approaches...