Archives of Iranian Medicine
Volume:11 Issue: 4, Jul 2008

The fall in the incidence of esophageal squamous cell cancer and noncardia gastric cancers in western countries parallels a concomitant rise in the incidence of gastric cardia cancer and distal adenocarcinoma of the esophagus. We aimed to investigate the incidence trend of different gastric and esophageal cancers in Kerman, southeast Iran. The information of all newly diagnosed patients with gastric and esophageal cancers were collected actively from all histopathology departments around the Kerman Province during 1991 – 2002 retrospectively. The annual age standardized incidence risks of esophageal and gastric cancers in Kerman were 1.9 and 6.9 per 100,000 populations. In average, the risks of gastric and esophageal squamous cell cancers were more or less constant, while the risk of adenocarcinoma of the esophagus increased around 11% annually. The risks of upper gastrointestinal cancers in Kerman Province were quite lower than the average risks in the whole country. The rising incidence of adenocarcinoma of the esophagus in Kerman parallels its temporal pattern in western countries.

Anti-Mullerian hormone is produced by the granulosa cells of preantral and small antral follicles. The objective of this study was to investigate whether anti-Mullerian hormone and antral follicle count can be useful in predicting the ovarian reserve and pregnancy outcome in assisted reproductive technology cycles. This prospective study included a total of 60 patients attending an assisted reproductive technology program. Patients with an oocyte count of ≥4 were considered good responders (group A); those with <4 oocytes were considered as poor responders (group B). On day three of the menstrual cycle, blood sample was taken from each woman for the measurement of serum levels of FSH, LH, E2, and anti-Mullerian hormone. Thereafter, ovarian ultrasound scanning was performed to evaluate the number and size of antral follicles. Parameters such as serum FSH, LH, and E2 levels were not statistically different between the two groups. Meanwhile, the difference between serum anti-Mullerian hormone levels, AFC, HCG day follicle counts, and retrieved oocyte counts were statistically significant in the two groups. The mean±SD serum anti-Mullerian hormone level was 34.22±13.95 and 12.53±9.4 pM/mL in groups A and B, respectively (P=0.002). The number of chemical pregnancies was seven versus three in groups A and B, respectively (P=0.014), whereas the number of clinical pregnancies was six versus two in groups A and B, respectively (P =0.52). It appears that there is an association between the serum level of anti-Mullerian hormone in early follicular phase and ovarian reserve. Furthermore, a higher serum level of anti-Mullerian hormone on day three is associated with chemical pregnancy success

In general, no study has examined the relationship between vitamin D status and key parameters of bone mineral homeostasis in healthy men in Iran. The effects of age and renal function on vitamin D status were determined in a cross-sectional study on a healthy population of Iranian men. From January through February 2001, 520 men, aged 20 – 74 years were selected through a cluster randomized sampling from Shiraz. Serum 25-hydroxyvitamin D, intact parathyroid hormone, calcium, phosphorus, alkaline phosphatase, creatinine, and albumin were measured. Pearson and partial correlation coefficients were used to determine the association between variables. Five hundred twenty men with a mean±SD age of 45±15 years and a mean±SD 25-hydroxyvitamin D level of 35±17 nmol/L were enrolled into the study. Over 33.9% of men in Shiraz had a low level of 25-hydroxyvitamin D (≤25 nmol/L). Serum 25-hydroxyvitamin D did not decline with age in men. Serum parathyroid hormone increased significantly by age in men, but it did not correlate with the decline in creatinine clearance. Men had a decline in serum phosphorus (r=0.23, P<0.0001) and calcium (r=0.14, P=0.001) concentrations by age. Creatinine clearance declined with age. In healthy men, the serum level of 25-hydroxyvitamin D did not decline with age. Nonetheless, the prevalence of vitamin D deficiency is high which warrants consideration of dietary vitamin D supplement in men.

Single nucleotide mutations in α1 or α2 genes produce abnormal α-chain hemoglobins. Hemoglobin Q disorders including hemoglobin Q-Iran, hemoglobin Q-Thailand, and hemoglobin Q-India are important hemoglobin variants. Herein, we report on the presence and hematologic and molecular features of hemoglobin Q-Iran [α75 (EF4) Asp®His] in 20 members of 11 families including nine children and hemoglobin Setif [α94 (G1) Asp®Tyr] in 10 individuals from five families consisting of five children and their affected parents living in western Iran. A polymerase chain reaction-RFLP procedure using Ava II restriction enzyme was designed to confirm the presence of two α-chain variants. To find the coinheritance with α-thalassemia, the presence of deletions of -α3.7, -α20.5, --MED, --SEA, and nondeletion defects of IVSI (-5 bp) and hemoglobin CS was examined using polymerase chain reaction-based approaches. The mean±SD level of hemoglobin Q-Iran was 20.4±4.4%. Three out of 18 individuals with hemoglobin Q-Iran were heterozygous for -α3.7 deletion (-α3.7/αα). The coinheritance of hemoglobin Q-Iran and -α3.7 deletion resulted in significantly (P=0.002) higher levels of hemoglobin Q-Iran (26.7±3.8 %). In those heterozygous for hemoglobin Setif, the level of this hemoglobin was 17.8±5.6 %. The polymerase chain reaction-RFLP method described here is a simple, rapid, and inexpensive procedure for the diagnosis of abnormal α-chains in developing countries.

Paraquat is a bipyridil herbicide and in appropriate and careful usage, will not be health threatening. Most adult cases of intoxication are due to suicidal attempts rather than accidental exposure. Therapeutic response has been reported to be appropriate with high doses of cyclophosphamide and glucocorticoids and survival is reported to be approximately 75 %. So, this study was designed to evaluate the effects of combined treatment with cyclophosphamide and glucocorticoids in patients with paraquat poisoning. During a two-year period 45 patients with paraquat poisoning were admitted to Sina Hospital, Hamadan, Iran, of whom 20 had moderate to severe intoxication. Eleven patients (group 1) received conventional treatment and nine patients (group 2) received conventional treatment plus intravenous infusions of cyclophosphamide 15 mg/kg daily for two days, methylprednisolone one gram daily for three days, and mesna 15 mg/kg for four days. The mean age±SD in group 1 was 25±10 years and in group 2 was 26±10 years. In group 1 three patients were females and eight patients were males. In group 2 one patient was female and eight patients were males. There were no differences between the groups in the time elapsed from ingestion to presentation at hospital or in the beginning of hemodialysis. The mortality rate in group 1 was 81.8% and in group 2 was 33.3% (P< 0.05). All fatalities caused by acute respiratory distress syndrome. Pulse therapy with cyclophosphamide and methylprednisolone may be effective in preventing respiratory failure and reducing mortality in patients with moderate to severe paraquat poisoning

The objective of our study was to compare the zinc and molybdenum contents of nails in two populations at high and low risk for esophageal cancer in northern Iran. Four groups were studied including a control group in Tehran—a low-risk area (n=20); a group of patients with esophageal cancer from Sari—a moderate- risk region in northern Iran (n=20); a group of patients’ family members (n=20); and a control group in Sari (n=40). Molybdenum and zinc levels were measured in their nail samples using flame atomic absorption spectrometry. Both molybdenum and Zinc were significantly (P<0.01) lower in the Sari control group (molybdenum: 0.472 ppm, zinc: 173.0 ppm) compared with the Tehran control group (molybdenum: 0.740 ppm, zinc: 251.5 ppm). These elements were lower in content in patients with esophageal cancer (molybdenum: 0.283 ppm, zinc: 126.5 ppm) compared with the Sari control group (P<0.05 for molybdenum and P<0.001 for zinc). Only zinc was significantly (P<0.001) lower in patients compared with their family members (molybdenum: 0.456 ppm, zinc: 175.5 ppm). No differences were found between the Sari control group and the patients’ family members in any of the two elements. Zinc and molybdenum levels are much lower in north of Iran—a moderate- risk area for esophageal cancer—compared with Tehran—a low-risk area. Based on these results, more investigations on the relations of trace elements with esophageal cancer in high-risk areas in northern Iran are warranted.

As one of the most prevalent diseases globally and as an important cause of disability, depressive disorders are responsible for as many as one in every five visits to primary care doctors. Cultural variations in clinical presentation, sometimes make it difficult to recognize the disorder resulting in patients not being diagnosed and not receiving appropriate treatment. To address this issue, we conducted a qualitative pilot study on three ethnic groups including Fars, Kurdish, and Turkish in Iran to test the use of qualitative methods in exploring the explanatory models of help-seeking and coping with depression (without psychotic feature) among Iranian women. A qualitative study design was used based on an explanatory model of illness framework. Individual interviews were conducted with key informant (n=6), and depressed female patients (n=6). A hypothetical case vignette was also used in focus group discussions and individual interviews with lay people (three focus groups including 25 participants and six individual interviews; n=31). There were a few differences regarding help-seeking and coping mechanisms among the three ethnic groups studied. The most striking differences were in the area of treatment. Non-psychotic depressive disorder in all ethnicities was related to an external stressor, and symptoms of illness were viewed as a response to an event in the social world. Coping mechanisms involved two strategies: (1) solving problems by seeking social support from family and neighbors, religious practice, and engaging in pleasurable activities, and (2) seeking medical support from psychologists and family counselors. The Fars group was far more likely to recommend professional treatment and visiting psychiatrists whereas the other two ethnic groups (i.e., Turks and Kurds) preferred to consult family counselors, psychologists or other alternative care providers, and traditional healers. The study has educational and clinical implications. Cultural reframing of the patient’s and family’s perceptions about mental illness and depression may require community education. Family counseling, family therapy, and also religious practices can be used to empower the patient.

Subcutaneous injection of formalin in the plantar surface of rat’s hind paw is frequently used as an animal model to study pain associated with inflammation. The pain produced by formalin test differs significantly from that of acute noci­ceptive tests. In this study, we first investigated the cellular and molecular mechanisms responsible for chronic inflammatory pain-induced damage in the rat hepatocytes and finally we tried to figure out whether both selective (celecoxib) and nonselective (acetylsalicylic acid) cyclo-oxygenase inhibitors could protect hepatocytes against pain-induced damage. The male Wistar rats were divided in one-, four-, and seven-day pain groups. Twenty-four hours prior to pain induction with subcutaneous injection of 5% formalin into the hind paw, acetylsalicylic acid or celecoxib was administered to the animals of similar one-, four-, and seven-day pain groups. A no-pain (control) group was also considered for each of the experiments. Our results showed a significant rise in both formation of reactive oxygen species and collapse in the mitochondrial membrane potential (%ΔΨm) in all pain groups (P<0.05). Significant lysosomal membrane damage and hepatocyte proteolysis were only seen in one-and four-day pain groups (P<0.05). Caspase 3 activity also showed a significant (P<0.05) rise in all three pain groups. Formation of reactive oxygen species and mitochondrial/lysosomal damages were significantly inhibited by both acetylsalicylic acid and celecoxib in hepatocytes of all pain- suffering animals. Nonetheless, celecoxib’s tendency to raise caspase 3 activities, suggested that it accelerates the apoptosis in hepatocytes of pain-suffering animals. Our results showed that the pain per se, could initiate some harmful signals that affect other cells other than neurons; these malicious signals could be magnified by use of some analgesics particularly selective cyclo-oxygenase inhibitors.

Retinal vein occlusion is the second most common vascular disease of retina after diabetic retinopathy, affecting 1.6% of the population above the age of 40. The aim of this study was to compare the effect of dalteparin and aspirin in patients with recent-onset branch retinal vein occlusion. A randomized clinical trial was conducted on patients with branch retinal vein occlusion of less than 30 days'' duration. Ophthalmic, systemic, and hematologic evaluations were made. Visual acuity was measured with Early Treatment Diabetic Retinopathy Study chart. Patients in the dalteparin group received subcutaneous dalteparin 100 IU/kg twice daily for 10 days, then 100 IU/kg once daily for another 10 days while the patients in the aspirin group were given aspirin 100 mg daily throughout the study. Seventy-eight patients were enrolled, 37 in the dalteparin and 41 in the aspirin group. The patients were followed for six months. The visual outcomes of the two groups were compared. Although dalteparin improved mean visual acuity slightly more than aspirin, no statistically significant differences were found between the groups at one (P=0.37), two (P=0.16), three (P=0.11), or six (P=0.13) months. Resolution of macular edema and development of new vessels made no statistically significant difference between the groups [(P=0.08) and (P=0.49), respectively]. In recent-onset branch retinal vein occlusion, no significant difference was found in the final visual acuity between the patients treated by dalteparin or aspirin. A further study with larger sample size is recommended.

SEN virus is a blood-borne, single-stranded, nonenveloped DNA virus. Two of its strains (D and H), appear to be associated with non-A-to-E hepatitis more frequently than the others, although it is not clear whether this observation has any significance. The prevalence of SEN virus in otherwise healthy individuals, including blood donors, differs markedly by geographic region. In this study, an investigation to evaluate the prevalence of SEN virus strains among blood donors in Tehran was carried out. Sera of 260 blood donors who were negative for hepatitis B surface antigen (HBsAg) and third-generation hepatitis C virus antibody (anti-HCV) were tested for SEN virus-D and -H DNA. DNA was extracted from plasma of 260 blood donors and amplified by semi- nested polymerase chain reaction. SEN virus-D viremia was detected in four (1.5%) of the 260 blood donors (95% confidence interval (CI), 0.0 – 3%). SEN virus-H viremia was detected in 47 (18.08 %) of the 260 blood donors (95% CI, 13.4 – 22.8%). Both SEN virus-D and SEN virus-H viremia were detected in nine (3.4%) of the 260 blood donors (95% CI, 1.2 – 5.7%). SEN virus-D or SEN virus-H viremia was identified in 60 (23.08%) of the 260 blood donors (95% CI, 18.08 – 28.08%). Out of the 260 blood donors, 60 (23%) were infected by SEN virus-D/H. The prevalence of SEN virus-H is more than SEN virus-D. Our results also showed that the high prevalence of SEN virus in healthy blood donors with no history of blood transfusion may attribute to the transmission modes other than parenteral transmission.

Advances in molecular biology over the past decade have helped to enhance understanding of the complex interplay between genetic, transcriptional, and translational alterations in human cancers. These molecular changes are the basis for an evolving field of high-throughput cancer discovery techniques using microscopic amounts of patient-based materials. Laser capture microdissection allows pure populations of cells to be isolated from both the tumor and stroma in order to identify subtle differences in RNA and protein expression. Comparative analysis of these alterations between normal, preinvasive, and invasive tissue using powerful bioinformatics programs has allowed us to identify novel tumor markers, profile complex protein pathways, and develop new molecular-based treatments. Continued refinement of such high-throughput micro- technologies will enable us to rapidly query patient specimens to identify novel methods for early detection, treatment, and follow-up of a wide array of human cancers. Also in recent years there has been an explosion in the development of new tools to analyze the proteome of cells, blood, and other bodily fluids. An analysis of the proteome would enhance the possibility of identifying protein signa­tures for cancer. Surface enhanced laser desorption and ionization with time of flight (SELDI-TOF) detection spectral analysis is linked with a high-order analytical bioinformatics approach to define that optimal discriminatory signature pro­teomic pattern. This technology is now being widely used in laboratories around the world for biomarker discovery in early detection of cancer.

Since the discovery of the first microRNA gene, lin-4, in Caenorhabditis elegans in 1993, many of this small regulatory genes have been reported in plants, viruses, and various kinds of animals. This announced a new world of RNA molecules, which subverted our traditional thinking about RNA. In this review, I summarized the main findings from researchers at different laboratories on microRNAs importance, functionality, production, and different aspects of their biologic activities.A narrative literature overview of relevant papers known to the author and that were retrieved from PubMed is presented.MicroRNA, a nonprotein-coding small RNA with almost 21 – 23 nucleotides in length, is an essential regulatory apparatus in the cells and their environment. They are crucial molecules for development, evolution, cellular differentiation, proliferation, embryogenesis, and cell death. Two classes of microRNAs exist: small temporal RNA—stRNA (miRNAs) and small interfering RNA— siRNAs (RNAi). The latter is a useful tool for the diagnosis, treatment, and prevention of diseases particularly cancer and viral diseases.There have been tremendous research regarding various aspects of these genes silencing and regulatory molecules which are preserved in all kinds of creatures. Currently, about 1% of the known human genes encode microRNAs.

There are many descriptive studies on hypertension in Iran, mostly assessing the prevalence of the disease and its associations with various risk factors. In order to gain a better insight into the epidemiology of hypertension in Iran and its heterogeneity around the country, we systematically reviewed all available studies and analyzed their findings using meta-analysis methods. All published papers in Iranian and international journals, final reports of research projects, papers presented in relevant congresses, and also all dissertations of medical students were reviewed using standard keywords. Studies published during 1996 – 2004, which met the eligibility criteria were entered into meta-analysis. We found 38 studies, of which 29 were eligible with a total sample size of 93,661 subjects. Also, we accessed the results of a very large national survey, which reported the prevalence of hypertension in 27 provinces. Our estimation for the overall prevalence of hypertension in 30 – 55 and >55-year-old population were around 23% and 50%, respectively. The prevalence in men was 1.3% less than that in women (P<0.0001). The mean diastolic blood pressure in men was 0.62 mmHg less than that in women while the mean systolic blood pressure was 0.67 mmHg greater.We found a sharp increase in the prevalence of hypertension by age, and also greater risk in females. It seems that the overall prevalence of hypertension in Iran is considerable. Iranian health system should pay more attention to control and treatment of hypertension in general population.

Hepatitis B virus is a hepatotropic virus that causes acute and chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma; it is responsible for more than one million deaths annually worldwide despite hepatitis B vaccination. Until now, there are eight known genotypes (A-H).Clinical course of chronic hepatitis B varies according to the genotype of Hepatitis B virus. Liver biopsy becomes necessary to judge the degree of liver lesions and to make the final diagnosis, especially to make the diagnosis for latent liver damage and early-compensated cirrhosis. Genotype is very important for prognostication, but it has not yet been reported on liver tissues. Sometimes, it can be helpful to do genotyping of Hepatitis B virus of the liver tissue; such conditions include research programs, when serum is not available or when serum is negative for Hepatitis B virus DNA. In this study, we wanted to evaluate the feasibility of a simple method for genotyping of liver tissue samples. We performed genotyping of the liver biopsies and intended to find out a simple and reliable method for genotyping in the paraffin- embedded formalin- fixed liver tissue.Genotype D was the only isolated genotype in all the liver biopsies. The tissue genotype was just the same as that found in serum. The procedure was easy and good for large scale studies.Genotyping in the paraffin-embedded formalin-fixed stored liver tissue can be done with the same accuracy of the serum.

The authors describe a large Iranian family with autosomal dominant cerebellar ataxia, which included 14 patients in four generations. We examined seven patients who had expanded CAG repeats in the CACNA1A gene with repeat instability (24 and 25 repeats). Although all patients showed cerebellar ataxia, each patient exhibited peripheral neuropathy or spasticity indicating intrafamilial phenotypic variability.

Tuberculosis of the breast is an extremely rare disease, which is still present and is also misdiagnosed with carcinoma or bacterial abscesses. In this study, we reported on eight patients with mammary tuberculosis during a four-year period. The main signs and symptoms of the patients included a painful tender lump in the breast (n=4), a painless lump in the breast (n=3), a lump with sinus (n=1), a sinus without lump (n=1), and an ipsilateral axillary lymphadenopathy (n=1). The diagnosis was confirmed by fine-needle aspiration cytology or histology. Antitubercular therapy was the therapeutic mainstay. Surgical intervention was reserved for aspiration of cold abscesses, and excision of residual sinuses and masses.

A 40-year-old man presented with a sudden severe headache and complete right-sided ptosis. Neuro-ophthalmic examination revealed a right oculomotor nerve palsy. Computed tomography of the brain showed a round isodense intrasellar mass. Magnetic resonance imaging demonstrated a pituitary tumor with some areas of infarction and invasion into the right cavernous sinus, which was diagnosed as pituitary apoplexy. The patient received intravenous steroid for 10 days with no recovery of the oculomotor nerve palsy. He underwent trans-sphenoid tumor resection followed by complete recovery of the oculomotor nerve and no sign of tumor in postoperative MRI, two weeks after the surgery.

We present an elbow disarticulation due to accidental intra-arterial injection of diazepam. Considering the risk of inadvertent and accidental intra-arterial injection of diazepam and its subsequent severe sequelae that are reported in the literature, we emphasize that intravenous diazepam should be administered with more hesitancy and care.

The Pasteur Institute of Iran was inaugurated on August 24, 1921 in Tehran. This new institution was established on the request of the Iranian government with the agreement and scientific support of the French authorities under the supervision of Professor Pierre Paul Emile Roux (1853 – 1933), the General Director of the Paris Pasteur Institute of the time. The Iranian institute was inaugurated 33 years after the original institute was established in Paris on November 14, 1888.In this article, we will review briefly the founding of the Pasteur Institute of Iran, its early French directors and the main services it rendered in the first four decades of its activity.