ARCHIVES OF IRANIAN MEDICINE
Year:2019 | Volume:22 | Issue:11|Papers Count:10

Background: The burden of diabetes mellitus (DM) is increasing worldwide, especially in countries such as Iran. Modifiable correlates of the DM may be different across regions. We aimed to estimate the population-based prevalence of DM and its correlates among adults in southern Iran. Methods: Baseline data of the Pars Cohort Study (PCS) was analyzed. Demographic and socio-economic characteristics, alcohol consumption, opium and tobacco abuse and cigarette smoking, laboratory findings, anthropometric measurements and perceived body shape at 15 and 30 years of age using pictogram were measured and analyzed. The age-standardized prevalence of DM was estimated. Robust Poisson regression was applied to estimate adjusted prevalence ratio (aPR) and 95% robust confidence intervals (CI). A P value <0. 05 was considered statistically significant. Results: Out of 9264 individuals, 919 (9. 9%; 95% CI: 9. 3– 10. 6) had DM. The prevalence of DM among the males and females was 7. 6% (95% CI: 6. 8– 8. 5) and 11. 9% (95% CI: 10. 9– 12. 9), respectively. Higher age, female gender, high socioeconomic status and using antihypertensive medication were associated with higher DM prevalence. Also, triglyceride level, physical inactivity, higher body mass index (BMI), pictogram score at 15, and its change from 15 to 30 years of age were significantly associated with DM. Conclusion: Higher prevalence of modifiable factors such as physical inactivity and obesity among DM patients in the study population highlights the necessity of more effective preventive interventions in such settings, especially in younger ages.

Background: It is important to identify new biomarkers for early detection of complications and treatment success in patients with brucellosis. Methods: A total of 187 brucellosis patients in the Department of Infectious Diseases of Izmir Katip Celebi University Ataturk Training and Research Hospital were evaluated retrospectively from January 2010 to January 2016. Complications of brucellosis were hematologic, osteoarticular, genitourinary, neurologic, cardiovascular, gastrointestinal and ocular involvement. Specific organ involvement was defined as the presence of infection signs in any specific anatomic site except hematologic involvement. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte-ratio (PLR) were evaluated statistically to predict complications and specific organ involvement of brucellosis. Results: Complications occurred in 125 patients. We found that PLR and erythrocyte sedimentation rate (ESR) were higher in complicated patients (P = 0. 007, P < 0. 001). The area under curve (AUC) for PLR was 0. 622 (95% confidence interval [CI], 0. 538-0. 707) with a cutoff value of >119. 6 in predicting complications in brucellosis. LMR and NLR were not significant in terms of predicting complications in brucellosis. We also evaluated only specific organ involvement as a complication due to frequent occurrence of hematologic abnormalities in brucellosis. ESR, mean platelet volume (MPV), NLR, PLR and LMR were significantly different in patients with specific organ involvement (P = 0. 001, P = 0. 011, P = 0. 001, P = 0. 013 and P = 0. 040). The AUC values for NLR and LMR were 0. 649 (95% CI 0. 570– 0. 728) and 0. 589 (95% Cl 0. 507– 0. 671), respectively. Conclusion: These biomarkers are cost-effective, simple and broadly available parameters for predicting complications and specific organ involvement of brucellosis.

Background: The childhood obesity epidemic is one of the most serious global health challenges, and many relevant policies have been designed and implemented. Regarding health equity policy-making, it is important to adopt proper interventional strategies, including childhood obesity policies. The purpose of this study is to assess compliance with the WHO Ending Childhood Obesity (ECHO), and the Iran-Ending Childhood Obesity (IRAN-ECHO) program draft in terms of Urban Health Equity Indicators (UHEIs) in Iran. Methods: This is a descriptive study, using a directed quantitative content analysis approach to analyze the ECHO report and IRAN-ECHO program draft, based on Iranian UHEI. The UHEI consist of 52 indicators in 5 domains. The frequency of each code in the ECHO report and IRAN-ECHO draft was calculated and analyzed. Results: In total, 148 and 84 phrases or words in ECHO and IRAN-ECHO were encoded with UHEI concepts. The results showed that the physical activity indicator was the most frequent among indicators in both ECHO (n = 48, 32. 43%) and IRAN-ECHO (n = 41, 48. 80%). Indicators 28 (prevalence of underweight in children under 5, n = 14, 9. 45%) and 19 (use of primary care services, n = 21, 25%) were the next most frequent in ECHO and IRAN-ECHO, respectively. Conclusion: In this study, ECHO and IRAN-ECHO had high compliance with some UHEI, especially indicators placed in domain 3 (social and human development). It indicates that social and human development plays an important role in preventing and controlling childhood obesity.

Background: Non-traumatic intramural hematomas of the small bowel (IHSB) are rare conditions which occur due to anticoagulant therapy. In this study, we aimed to explain our clinical approach to non-traumatic IHSB due to anticoagulant overdose and to present the long-term outcomes of the cases who were hospitalized. Methods: Sixteen patients with non-traumatic IHSB were included and their medical records were retrospectively reviewed. Results: Our patients included ten women and six men, with a mean age of 77. 5 ± 8. 4 (range: 65– 95) years. All patients had been using oral anticoagulants (OACs) due to various cardiovascular and cerebral comorbidities. Common complaints at the time of admission included abdominal pain, vomiting and weakness. Ten patients (62%) had anemia, fifteen (94%) had leukocytosis and all patients (100%) had high levels of C-reactive protein (CRP). Abdominal computed tomography (CT) established the final diagnosis of IHSB in all patients. Fourteen patients (87%) were followed up with conservative therapy. Since the clinical course did not improve in two patients (12%), surgery was mandated. The mean duration of hospitalization was 10. 25 ± 3. 6 days (range: 3– 17 days). Mortality occurred in two patients (12%). Conclusion: IHSB should be considered in patients presenting with abdominal complaints and increased levels on coagulation tests. The diagnosis should be confirmed by abdominal CT scan, if possible. Accurate and timely diagnosis allows patients to be successfully treated without need for surgery.

Background: The prevalence of microorganisms in the neonatal intensive care unit (NICU) and neonatal internal wards is constantly changing, thus rendering the practice of empiric antibiotic therapy ineffective due to the resistance of these microorganisms. Therefore, the purpose of this study was to determine the relative frequency of positive cultures of Bactec, blood, cerebrospinal fluid (CSF) and urine in infants admitted to the NICU and neonatal internal ward in Al-Zahra hospital in 2011-2017. Methods: In this cross-sectional descriptive study, we evaluated 466 positive culture samples from 2853 different cultures (blood, urine, CSF, etc) from infants admitted to the NICU and neonatal internal ward with clinical signs of neonatal infection in Al-Zahra hospital. Isfahan in 2011-2017. The samples were evaluated for type of microorganisms and sensitivity to antibiotics. Results: Positive cultures among Bactec, blood, CSF and urine culture samples were reported at 15. 5% (95% confidence interval [CI]: 12. 8– 18. 1) 9. 3% (95% CI: 6. 8– 11. 7), 6. 4% (95% CI: 4. 3– 8) and 28. 6% (95% CI: 25. 4– 31. 7), respectively. Staphylococcus epidermidis was the most common species in Bactec (46. 7%; 95% CI: 38. 7– 54. 6), blood (53. 1%; 95% CI: 39. 1– 67), and CSF (37. 1%; 95% CI: 21– 53. 1) cultures while Klebsiella pneumoniae was the most frequent species in urine culture (28%; 95% CI: 22. 2– 33. 7). Conclusion: Considering the results of Bactec and blood cultures, it is essential to reduce staphylococcal infections in our settings.

Due to advances in surgical procedure, anesthesia techniques, blood transfusion and antibiotic therapy, the technique of cesarean section has been progressing over the time. However, cesarean section is still a risk-specific operation, with long-term and short-term consequences for the mother and neonate. The rate of cesarean surgery is constantly growing due to both justifiable and non-justifiable medical and non-medical reasons. There is evidence indicating that efforts are made in many countries to reduce the rate of cesarean delivery. In this review article, we try to assess the frequency of cesarean section in different countries, especially Iran. We searched several keywords, including cesarean section prevalence, cesarean section rate, world, delivery, Iran and health policies within the newest articles published in Google Scholar, PubMed, and ISI/Web of Sciences, as well as Iranian databases (Magiran, SID), from January 2017 to April 2019. The results show that there is still a high prevalence of C-section. In Iran, the highest rate of cesarean was in Tehran province (62. 1%-72. 1%) and the lowest was in Sistan and Baluchestan province (12%). It appears necessary to plan for effective interventions in terms of painless vaginal delivery, improving the quality of vaginal delivery services, proper culture and education.

Methanol is a clear liquid with high toxicity. Methanol intoxication may result from accidental exposure, overconsumption of compounds containing methanol with suicidal intent, or following consumption of distilled and contaminated alcoholic beverages. This report describes a case of transdermal methanol intoxication, which is a rare condition. A 58-year-old woman presented with nausea, vomiting, weakness, diplopia and dizziness. On neurological examination, she only had diplopia. On physical examination, a hyperemic lesion with clear borders was found over the right knee. The patient’ s recent medical history revealed that four days prior to the onset of symptoms, she had covered her knee with a methanol-soaked bandage in an attempt to alleviate her knee pain. She had a high osmolar gap as well as high anion-gap metabolic acidosis (HAGMA). Methanol intoxication was suspected due to HAGMA and high osmolar gap. Serum methanol levels were subsequently measured and found to be 37. 9 mg/dL. The patient was treated with intravenous (IV) bicarbonate, IV ethyl alcohol and hemodialysis. She was discharged with no central nervous system or ophthalmologic sequelae. Methanol poisoning should be kept in mind in patients with diplopia and unexplained metabolic acidosis. Although most methanol intoxication cases occur after oral ingestion, it should be considered that methanol poisoning may occur transdermally.

A 27-years-old man was referred to the emergency department of the Tohid hospital of Sanandaj with fever, tachypnea, tachycardia and purulent sputum-producing cough....

Delpy came to Iran as the third director of the Hesarak Vaccine and Serum Institute (Razi) in 1931 and revolutionized the institute by performing diagnostic and vaccine-producing techniques for 20 years. Dr. Delpy, as a veterinary microbiologist, was employed partly to control the outbreaks of rinderpest, but he did more important and lasting work in controlling other infectious and parasitic diseases, production of serums and vaccines, and developing tick taxonomy in Iran. Delpy was a very modest scientist who died in 1974 in France.

Dear Editor, The paper published by Lotfi et al1 concerning the public health of the Iranian population explores three polymorphisms of genes that code for proteins that contribute to drug-related treatment of ulcerative colitis (UC): CYP2D6, NAT2 and MDR1. We analyzed the data shown in Tables 2 and 3 of both cases and control subjects, using the Epi InfoOpen program of the CDC. We found that the allele CYP2D6* 4 G variant is associated as a protective factor with the development of UC with χ 2= 3. 812, df = 1, P = 0. 05088, odds ratio (OR) = 0. 8163 (95% CI= 0. 6776– 0. 9834) (see Table 1), while the A allele was associated as a risk factor; χ 2 = 3. 812, df = 1, P = 0. 05088, OR = 1. 2251 (95% CI = 1. 017– 1. 476). While Lotfi et al have only reported the allele A as a risk factor (OR = 1. 56, P = 0. 0471), both results are important.