ARCHIVES OF IRANIAN MEDICINE
Year:2019 | Volume:22 | Issue:10|Papers Count:15

Background: The benefits of tricuspid valve (TV) repair in patients with moderate tricuspid regurgitation (TR) during left-sided valve surgery are under debate. We investigated independent predictors for reduction in TR severity following left-sided valve surgery in patients with moderate TR. Methods: In this study, we included 106 patients (male: 33%) with a mean age of 4. 23 ± 12. 61 years who had moderate TR and underwent mitral or aortic valve surgery between March 2012 and November 2016. Concomitant tricuspid annuloplasty was done for one group of patients based on surgeon’ s decision. Transthoracic echocardiography was done before and at a median follow-up of 4. 71 months for all patients. The patients were divided into improved and unimproved TR groups, with the term “ improved” signifying a reduction of at least one grade in TR severity. Results: Tricuspid annuloplasty was performed on 65 (61. 3%) patients. TR improvement was observed in 87. 7% of patients in the TV repair group and 56. 1% of patients in the no-TV repair group, indicating a significant difference (P < 0. 001). Tricuspid annulus diameter was not significantly different between the two groups (32. 41 ± 4. 68 mm in no-TV repair group and 33. 87 ± 4. 34 mm in TV repair group, P = 0. 128). At follow-up with echocardiography, 80 (75. 5%) patients were placed in the improved group and the majority of patients (71. 3% vs. 30. 8%; P < 0. 001) underwent tricuspid repair in the improved group. TV annuloplasty was correlated with reduced TR severity following left-sided valve surgery (odds ratio [OR]: 5. 19, 95% CI: 1. 70– 15. 85, P < 0. 001). TR changed from moderate to severe in 17 (17. 1%) patients with no concomitant tricuspid repair, while only one patient (1. 5%) with tricuspid repair showed an increased TR severity. Conclusion: Tricuspid annuloplasty may be useful in patients who have moderate TR undergoing left-sided valve surgery regardless of the tricuspid annulus diameter, and it can play an effective role in the improvement of TR at mid-term follow-up.

Background: Measuring the amount of opium use is a challenge in epidemiologic studies. Self-report of amount of opium use at each consumption, widely used in the literature, usually fails to provide a good estimate. The purpose of this study is to systematically study the perceived weight units of reported opium use in Iran, and compare them to the standardized units of weight measurement. Methods: An exploratory descriptive study was conducted in six major cities of Iran. Study participants were interviewed and asked to use a Play-Doh-like material to demonstrate the amount of opium they use. To obtain an estimate of the weight of the material used, we multiplied the volume by the density of the opium product. We experimentally determined the density of the commonly used opium products. We used medians and inter-quartile ranges (IQRs) to report the typical amount of each unit. Results: A total of 108 individuals participated in this study. The most frequently reported unit was “ gram” ; the median perceived weight for one gram (g) of opium was 0. 24 (IQR: 0. 16) g. The second most commonly used unit was nokhod with a median of 0. 16 (IQR: 0. 16) g, followed by mesghaal and hab/habeh, which were 1. 28 (IQR: 0. 81) and 0. 16 (IQR: 0. 16) g, respectively. The median perceived weight of mesghaal and gram in the studied cities was less than the expected standardized values. Conclusion: In conclusion, the reported amount of opium use is highly inaccurate and unreliable, and is mainly subject to underestimation.

Background: There is no clear picture regarding the prevalence rates of autism and its comorbidities among Iranian children and adolescents. The present study aimed to estimate these rates as part of a large national population-based study on epidemiology of psychiatric disorders in Iranian children and adolescents. Methods: The total sample consisted of 31 000 children and adolescents between 6 to 18 years of age. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Present and Life time version (K-SADS-PL) was used as the diagnostic tool. Results: The prevalence of autism in the total sample is equal to 0. 1% (10 per 10 000), with a 2: 1 male-to-female ratio. In total, 86% of people with autism had at least one comorbid condition. Intellectual disability, epilepsy, enuresis and attention deficit and hyperactivity disorder (ADHD) with prevalence rates of 70. 3%, 29. 7%, 27% and 21. 62%, respectively, were the most prevalent comorbid conditions in people with autism. Maternal personality disorders were also shown to be associated with increasing risk of autism. Conclusion: The present study shows high prevalence rates for autism and its comorbid conditions among Iranian children and adolescents. It also reveals that there is a relationship between some maternal psychiatric disorders and the risk of autism.

Background: Migraine is a debilitating neurological disorder with a high prevalence. This study was conducted to evaluate the relationship between body mass index (BMI) and disability, severity, frequency and duration of headaches in female migraine patients. Methods: This cross-sectional study was designed to address the characteristics of migraine attacks (duration of each attack, frequency, and severity) and MIDAS (Migraine Disability Assessment) score in female migraineurs. The diagnosis of migraine was based on ICHD-3 beta criteria. Verbal rating scale (VRS) was used for headache severity. Height and weight were measured to calculate the BMI. Mann-Whitney and Kruskal-Wallis tests were used for comparison of means, and analysis of covariance (ANCOVA) test was used for adjustment of the confounding factors. Results: In the current study, 170 female migraine patients with a mean (± SD) age of 34. 0 ± 8. 0 years were enrolled. There were significant differences between the three groups (18. 5 ≤ BMI< 25, 25 ≤ BMI < 30 and 30 ≤ BMI) in terms of headache frequency, duration and severity as well as total MIDAS score (P < 0. 001). These differences remained significant after adjustment for age. Conclusion: This study revealed that migraineurs with higher BMI experienced higher headache frequency, severity and duration as well as higher disability score.

Background: This study aims to investigate the prevalence of metabolic syndrome (MetS) in familial Mediterranean fever (FMF) and the relationship between serum uric acid (SUA) concentrations and MetS status by sex in patients with FMF. Methods: This cross-sectional study included all attack-free patients previously diagnosed with FMF who referred to the rheumatology clinic for follow-up between October 2018 and January 2019. This study included 154 patients with FMF (66 males and 88 females) and 154 controls (62 males and 92 females) with similar age and sex. Results: MetS was more prevalent among the FMF patients compared to the controls (42. 90% [95% CI: 34. 9– 51. 1%) vs. 28. 57% [95% CI: 21. 6– 36. 4%); OR = 1. 88, 95% Cl: 1. 17– 3. 01, P = 0. 009]. In the FMF group, we found higher SUA, number of MetS components, body mass index (BMI), waist circumference (WC), and insulin compared to the control group (P < 0. 001, P < 0. 001, P = 0. 018, P = 0. 002, P = 0. 008, respectively). The prevalence of MetS (men: P < 0. 001, women: P < 0. 001) and number of MetS components (men: P < 0. 001, women: P < 0. 001) were significantly increased with increasing SUA quartiles in both sexes. Conclusion: The prevalence of MetS was higher in patients with FMF, and the prevalence of MetS and number of MetS components were significantly increased with increasing SUA quartiles in both men and women with FMF. SUA levels, as a biochemical marker, could be a strong and independent predictor of MetS in patients with FMF, and may provide substantial help with early diagnosis and management of MetS.

Background: This randomized controlled trial compares the effects of walnuts, fish and the combination of the two on cardiovascular risk factors among overweight or obese females who were losing their weight. Methods: Ninety-nine overweight and obese women were randomized to 3 weight-reducing diets: fish (300 g/week), walnut (18 walnuts/per week) or fish + walnut (150 g fish and 9 walnuts /week) for 12 weeks. Anthropometric indices, systolic & diastolic blood pressure, fasting blood glucose, inflammatory markers, serum lipids and coagulating factors were measured. Results: The reduction in systolic blood pressure (SBP) (-5. 0 ± 0. 3 mm Hg, P = 0. 01), fasting blood glucose (FBG) (-12. 4 ± 1. 9 mg/dL, P = 0. 001), low-density lipoprotein (LDL) (-6. 2 ± 1. 3 mg/dL, P = 0. 03), high-sensitivity C-reactive protein (CRP) (-0. 51 ± 0. 08 mg/L, P < 0. 001), D-dimer (-0. 45 ± 0. 07 mg/dL, P < 0. 001), fibrinogen (-22. 4± 4. 5 mg/dL, P < 0. 001), alanine aminotransferase (ALT) (-6. 4 ± 0. 9 mg/dL, P < 0. 001), aspartate aminotransferase (AST) (-6. 3 ± 0. 9 IU/L, P = 0. 01), tumor necrosis factor-alpha (TNF-α ) (-0. 08 ± 0. 02 ng/mL, P = 0. 01), interleukin 6 (IL-6) (-1. 6 ± 0. 1 ng/mL, P < 0. 001) and increase in high-density lipoprotein (HDL) (3. 6 ± 0. 2 mg/dL, P < 0. 001) were significantly higher in the group randomized to the fish + walnut diet compared with either the fish group or the walnut group. A significant decrease was seen in TG (-7. 3 ± 1. 1 mg/dL, P < 0. 001) and diastolic blood pressure (DBP) (-2. 0 ± 0. 06 mm Hg, P = 0. 01) levels in the fish group and the walnut group compared with the fish + walnut group. The change in other risk factors was not different among groups. Conclusion: The present study shows that the combination of marine and plant omega-3 together is more effective on blood pressure levels, fasting blood glucose, inflammatory markers, serum lipids and coagulating factors than the fish or walnut in isolation.

Background: It is suggested that pregnancy-associated plasma protein-A (PAPP-A) levels below the fifth percentile or less than 0. 4 multiples of the median (MoMs) during the first trimester are closely associated with higher risk for neonatal abnormalities. We assessed the value of PAPP-A within the first trimester for predicting pregnancy outcome. Methods: In a historical cohort study, we assessed 8460 consecutive pregnant women recruited for chromosomal abnormalities screening within the first trimester at Fertility Infertility and Perinatology Research Center, in Ahvaz Jundishapur University of Medical Sciences between April 2014 and April 2015. The women were categorized into two groups: pregnant women with PAPP-A levels below 0. 4 multiples of MOM (n = 237) and those with higher levels of PAPP-A (n = 237). Results: The median value of MOM PAPP-A was 0. 82 ± 0. 78, with 237 women having MOM PAPP-A lower than 0. 4. Compared to women with MOM PAPP-A higher than 0. 4, those with lower MOM PAPP-A had higher mean age, lower gestational age and lower birth weight. The prevalence of small for gestational age (SGA) was higher in women with MOM PAPP-A <0. 4 compared to others. According to the ROC curve analysis, MOM PAPP-A <0. 4 had a high value for predicting SGA. best cutoff value for MOM PAPP-A to predict SGA was shown to be 0. 25, yielding a sensitivity of 84. 7% and a specificity of 68. 6% Conclusion: Measuring the serum level of MOM PAPP-A during the first trimester is a valuable marker for predicting adverse outcomes of pregnancy such as SGA.

Blood-borne infections are life-threatening challenges among prisoners. The aim of this study was to determine the prevalence of these infections and related risk behaviors among male prisoners. This cross-sectional study was performed on 1, 034 voluntarily enrolled male prisoners in several prisons of Kermanshah province, Iran. All participants completed a questionnaire and were interviewed by an expert. To test the presence of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections, 5-mL samples of blood were collected from all participants. Multivariable logistic regression was used to assess the association of HBV, HCV and HIV infections with the related risk factors. Totally, 1034 male prisoners participated in the current study. The mean age of subjects was 35. 52 ± 8. 12 years, with a range of 19-64 years. The prevalence rates of HBsAg+, HCVAb+, and HIVAb+ in male prisoners were 1. 25% (95% CI: 0. 67-2. 14), 22. 2% (95% CI: 19. 7-24. 2), and 3. 09% (95% CI: 2. 1-4. 3), respectively. Backward logistic regression analysis demonstrated a marked association between history of intravenous drug use and HBsAg+. There was also a positive association between HCVAb+ and age, region, age at the time of first substance use, and history of intravenous drug use and camp residency, as well as heterosexual relationships. HIV infection was also significantly associated with history of intravenous drug use and homosexual relationships. Although HBV infection was shown to be lower in Kermanshah than other parts of the country, a higher prevalence was found for HCV and HIV infections in this province.

The Islamic revolution of 1979 in Iran emphasized social justice as a pillar for development. The fundamental steps towards universal equitable access to high-quality healthcare services began with the creation of the Ministry of Health and Medical Education (MoHME) and the nationwide establishment of primary healthcare (PHC) network in 1985. Now, in the 40th anniversary of the Islamic revolution, the history of health system development in Iran is characterized by constant policy changes; i. e. structural and procedural transformations. Ever since and despite the imposed 8-year war with Iraq and continuous unfair sanctions against the country, noticeable progress has been achieved in the health system that has led to better population health including among others: self-sufficiency in training health workforce; advances in public health and medical sciences; establishment and expansion of health facilities within the hard-to-reach areas aiming to enhance equity in access to needed healthcare services; domestic production of most medicines and medical equipment; and meaningful expansion of health insurance coverage. These have led to admirable improvement in public health indicators; i. e. maternal mortality, child mortality, life expectancy, and vaccination coverage. Despite achievements, there still remain challenges in health financing, protecting the public against high expenditure of medical care, establishment of referral system and rationalization of service utilization, provision of high quality healthcare services to all in need, and conflict of interest in health policy making, all of which may hinder the goal to reach “ universal health coverage” , identified as the main goal of the health system in Iran by 2025. Recently, the MoHME began structural and functional reforms to boost societal efforts and enhance intersectoral collaboration to address social determinants of health, improve actions for prevention and control of non-communicable diseases and other social health problems. Drawing upon the World Health Organization (WHO)’ s “ six building blocks” model, this article presents an analytical description of the main health policy reforms during the last four decades after the Islamic revolution in Iran, divided by each decade. Learning from the historical reforms will create, we envisage, a better understanding of health system developments, its advances and challenges, which might in turn contribute to better evidence-informed policy making and sustainable health development in the country, and perhaps beyond.

The aim of this study was to assess the current applicability of articles that show important advances in medicine. The recruited papers include those published fifty years ago in the most respected journals in the USA, England and Germany. Using PubMed Central citations since 2010, original articles closely related to papers published in 1966 in the New England Journal of Medicine (NEJM), the Lancet and the Deutsche Medizinische Wochenschrift (DMW) were identified. In the NEJM, there were 163 observational articles, 18 clinical, and 117 case reports. In the Lancet, there were 390 observational articles, 29 diagnostic, 82 therapeutic, 38 animal, 28 in vitro studies and 61 case reports. In the DMW, there were 77 observational articles, 39 therapeutic, 28 diagnostic, 7 animal, 4 in vitro, 9 other studies and 57 case reports. The number of highly relevant articles still currently cited were determined as 12/298 (4%) in the NEJM, 11/ 628 (1. 7%) in the Lancet and 1/221 (0. 45%) in the DMW (0. 45%). It was concluded that “ half-hundred years impact index” should be regarded as a measure of ‘ relevance and quality over time’ . Combined with impact factor, it could be a better indicator for importance of scientific journals.

Background: Acute and severe infections are an absolute indication for the use of intravenous broad-spectrum antibiotics. However, previous studies have found inconsistent clinical advantages of prolonged (extended [≥ 3-hour infusion] or continuous [24-hour fixed rate infusion]) over intermittent (6, or 8, or 12 interval hours infusion) infusion. The clinical superiority between prolonged and intermittent infusion in treating acute and severe infections thus continues to be elusive. We conducted a meta-analysis to summarize all published randomized controlled trials (RCTs), prospective and retrospective observational studies to determine whether prolonged infusion, compared to intermittent infusion, is correlated with lower mortality and better clinical outcome. Methods: We performed a literature search using MEDLINE (source PubMed, January 1, 1966 to August 31, 2018) and EMBASE (January 1, 1980 to August 31, 2018) with no restrictions to collect RCTs and observational studies comparing prolonged infusion with intermittent infusion of the same intravenous administered antibiotics among adult hospitalized patients. A total of 43 studies including 30 RCTs, 5 prospective observational studies and 8 retrospective observational studies were identified. Results: In comparison with intermittent infusion, prolonged infusion of antibiotics was associated with a reduction in all-cause mortality (pooled relative risk [RR] = 0. 77, 95% confidence interval [CI] = 0. 66– 0. 89) and improvement in clinical cure (RR = 1. 11, 95% CI = 1. 04– 1. 19), which was also observed in subgroups such as non-RCTs (mortality, RR = 0. 63, 95% CI = 0. 48– 0. 81; clinical cure RR = 1. 33, 95% CI = 1. 13– 1. 57) or studies with patients and APACHE II scores  15 (mortality, RR = 0. 74, 95% CI 0. 63– 0. 89; clinical cure RR = 1. 19, 95% CI = 1. 07– 1. 32). Moreover, in RCTs, mortality (RR = 0. 86, 95% CI 0. 72– 1. 03) between the two dosing strategies was not remarkably changed but clinical cure (RR = 1. 07, 95% CI = 1. 01– 1. 13) showed a significant advantage for prolonged infusion. Additionally, no significant differences in mortality between the two dosing strategies was found (RR = 0. 87, 95% CI = 0. 70– 1. 09) but a distinct improvement in clinical cure was observed (RR = 1. 14, 95% CI = 1. 02– 1. 28) in the prolonged infusion group for septic patients. Among two infusion modes, statistically significant severe adverse events were not reported (RR=0. 83, 95% CI = 0. 62– 1. 13). Conclusion: Better outcomes in hospitalized patients, especially in those who were critical ill, were reported in prolonged infusion of intravenous antibiotics compared with traditional intermittent infusion.

Monosomy 18p syndrome is one of the prototypical examples of autosomal terminal deletions. This deletion can be the consequence of de novo deletions, malsegregation of a balanced parental translocation, cryptic subtelomeric deletions or ring chromosome 18. The present case is a rare cytogenetic variant of monosomy 18 as a consequence of whole-arm translocation between chromosomes 13 and 18 which has been reported only three times previously.

A previously healthy 46-year-old male referred to the hospital with low-grade fever and loss of appetite, as well as a productive cough with clear expectoration for three months. He was a chronic smoker (20 pack-years) and worked in close contact with soil and poultry. On admission, he was eutrophic and the rest of his physical examination was unremarkable. Routine laboratory exploration yielded results within normal ranges. Additionaly, sputum examination was negative for microorganisms and malignat cells.....

Dear Editor, The plateau of Iran, an ancient landmark dating back to 7000 years ago, has realized various civilizations, each of which has had its unique art, culture, and therapies. Despite the remarkable geographical distribution of Iran and the multiplicity of its civilization, many aspects have remained neglected. Hence, investigation and presentation of the mentioned aspects is of great value and can shed more light on the cultural roots of these civilizations....