Archives of Iranian Medicine
Volume:15 Issue: 2, Feb 2012

The incidence of major risk factors of chronic kidney disease (CKD) in the world is on the rise, and it is expected that this incidence and prevalence, particularly in developing countries, will continue to increase. Using data on urinary sediment and microalbuminuria, we aimed to estimate the prevalence of CKD in northeast Iran. In a cross-sectional study, the prevalence of CKD in a sample of 1557 regionally representative people, aged ≥ 18 years, was analyzed. CKD was determined based on glomerular filtration rate (GFR) and microalbuminuria. Life style data, urine and blood samples were collected. Urine samples without any proteinuria in the initial dipstick test were checked for qualitative microalbuminuria. If the latter was positive, quantitative microalbuminuria was evaluated. Of 1557 enrolled subjects in this study, 46.76% were male with a mean age of 56.76 ± 12.04 years. Based on the modification of diet in renal disease (MDRD) equation, 137 subjects (8.89%) were categorized as CKD stages III-V. Based on urine abnormalities, the prevalence of combined CKD stages I and II was 10.63%, and based on macro- and microalbuminuria it was 14.53%. The prevalence of CKD was significantly associated with sex, age, marital status, education, diabetes mellitus (DM), hypertension (HTN), ischemic heart disease (IHD), waist to hip ratio, myocardial infarction (MI), and cerebrovascular accident (CVA). CKD and its main risk factors are common and represent a definite health threat in this region of Iran. Using and standardizing less expensive screening tests in low resource countries could be a good alternative that may improve the outcome through early detection of CKD.

This study estimated the true prevalence of chronic motor and vocal tic disorders, and Tourette’s syndrome in students as well as its comorbidity with attention deficit/hyperactivity disorder (ADHD). A random clustered sample of elementary students was selected from schools in Tabriz, Iran. Students were screened by Conner’s teacher rating scale for ADHD and a detailed history from parents and teachers for the presence of any type of tic was obtained. Next, a clinical interview based on the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL), and an interview with parents lead to the definitive diagnosis. A total of 1658 children were evaluated. Vocal tic was observed in 3.2% (±SD = 0.02) students, and was more prevalent in boys. ADHD was diagnosed in 45.5% of these students. Motor tic was observed in 7.3% (±SD = 0.02) of students. Almost half (48.1%) of these students had ADHD. Tourette’s syndrome was observed in 1.3% (±SD = 0.01), with a male/female ratio of 3.5:1. This is the first study to provide the prevalence of chronic tics in elementary school students in Iran. ADHD is more common among students with chronic tics and Tourette’s syndrome.

This study estimated the true prevalence of chronic motor and vocal tic disorders, and Tourette’s syndrome in students as well as its comorbidity with attention deficit/hyperactivity disorder (ADHD). A random clustered sample of elementary students was selected from schools in Tabriz, Iran. Students were screened by Conner’s teacher rating scale for ADHD and a detailed history from parents and teachers for the presence of any type of tic was obtained. Next, a clinical interview based on the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL), and an interview with parents lead to the definitive diagnosis. A total of 1658 children were evaluated. Vocal tic was observed in 3.2% (±SD = 0.02) students, and was more prevalent in boys. ADHD was diagnosed in 45.5% of these students. Motor tic was observed in 7.3% (±SD = 0.02) of students. Almost half (48.1%) of these students had ADHD. Tourette’s syndrome was observed in 1.3% (±SD = 0.01), with a male/female ratio of 3.5:1. This is the first study to provide the prevalence of chronic tics in elementary school students in Iran. ADHD is more common among students with chronic tics and Tourette’s syndrome.

This study estimated the true prevalence of chronic motor and vocal tic disorders, and Tourette’s syndrome in students as well as its comorbidity with attention deficit/hyperactivity disorder (ADHD). A random clustered sample of elementary students was selected from schools in Tabriz, Iran. Students were screened by Conner’s teacher rating scale for ADHD and a detailed history from parents and teachers for the presence of any type of tic was obtained. Next, a clinical interview based on the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL), and an interview with parents lead to the definitive diagnosis. A total of 1658 children were evaluated. Vocal tic was observed in 3.2% (±SD = 0.02) students, and was more prevalent in boys. ADHD was diagnosed in 45.5% of these students. Motor tic was observed in 7.3% (±SD = 0.02) of students. Almost half (48.1%) of these students had ADHD. Tourette’s syndrome was observed in 1.3% (±SD = 0.01), with a male/female ratio of 3.5:1. This is the first study to provide the prevalence of chronic tics in elementary school students in Iran. ADHD is more common among students with chronic tics and Tourette’s syndrome.

Hepatitis B is one of the most common infectious diseases worldwide that can be transmitted by blood transfusion. The hepatitis B virus (HBV) has eight different genotypes that show different geographical distributions and clinical manifestations. This study aims to investigate the sequence of the HBV polymerase gene and the frequency of HBV genotypes among Iranian blood donors.The sera of 223 blood donors who were positive for hepatitis B surface antigen (HBsAg) as determined by the ELISA method were selected. HBV DNA was extracted from the sera of 134 blood donors by a commercial kit, and the entire polymerase gene was amplified by nested-PCR. HBV genotypes were determined by direct sequencing of the HBV polymerase gene. Phylogenetic trees were constructed by the neighbor-joining (NJ) method.No known base mutations were found in the entire HBV polymerase gene of infected blood donors, and only genotype D was detected among HBV-infected blood donors. The sub-genotype D1 of HBV was dominant in the subjects.This study shows that antiviral-resistant mutations, such as lamivudine-resistant HBV strains, do not exist naturally among Iranian blood donors. More studies on the full-length HBV genomes are required to determine genome evolution of HBV among infected Iranian blood donors.

Hepatitis B is one of the most common infectious diseases worldwide that can be transmitted by blood transfusion. The hepatitis B virus (HBV) has eight different genotypes that show different geographical distributions and clinical manifestations. This study aims to investigate the sequence of the HBV polymerase gene and the frequency of HBV genotypes among Iranian blood donors.The sera of 223 blood donors who were positive for hepatitis B surface antigen (HBsAg) as determined by the ELISA method were selected. HBV DNA was extracted from the sera of 134 blood donors by a commercial kit, and the entire polymerase gene was amplified by nested-PCR. HBV genotypes were determined by direct sequencing of the HBV polymerase gene. Phylogenetic trees were constructed by the neighbor-joining (NJ) method.No known base mutations were found in the entire HBV polymerase gene of infected blood donors, and only genotype D was detected among HBV-infected blood donors. The sub-genotype D1 of HBV was dominant in the subjects.This study shows that antiviral-resistant mutations, such as lamivudine-resistant HBV strains, do not exist naturally among Iranian blood donors. More studies on the full-length HBV genomes are required to determine genome evolution of HBV among infected Iranian blood donors.

Improved survival in thalassemic patients has lead to the manifestation of morbidities such as renal dysfunction. This involvement suggests the need for a reliable and non-invasive method to assess the degree of kidney iron overload. We conducted the present study to evaluate the relationship between serum ferritin levels, liver, heart, and kidney MRI gradient echo (T2*) relaxation times in thalassemic patients, as a step to evaluate the feasibility of using MRI T2* to assess the degree of kidney iron overload. This was a prospective study of 120 (60 males, 60 females) regularly transfused thalassemic patients (mean age: 25.9 ± 9 years) who suffered from major and intermediate thalassemia. Patients attended an adult thalassemia clinic located in Tehran, Iran. Cardiac, hepatic and renal MRI T2* were performed. Serum ferritin levels were measured. Our results indicated a moderate correlation between kidney MRI T2* relaxation time and serum ferritin (r = -0.446, P < 0.001). Kidney MRI T2* relaxation time weakly correlated with liver MRI T2* relaxation time (r = 0.388, P < 0.001) and cardiac MRI T2* relaxation time (r = 0.338, P = 0.023). The moderate correlation between kidney MRI T2* relaxation time and serum ferritin, and its weak correlation with liver and heart T2* relaxation times indicate that relying on liver and heart MRI T2*, as well as serum ferritin levels to predict the exact condition of kidney iron overload might not be a reliable approach. Our findings suggest the use of kidney MRI T2* as a noninvasive method for evaluating renal iron overload in thalassemic patients. Further studies to investigate the relation between kidney MRI T2* relaxation times and renal function, as well as the cost benefit of using this method, are suggested.

Sleep disturbances are common among adult populations and can have a significant effect on daytime activities. The aim of this study is to determine the prevalence of sleep problems and subjective sleep quality in the adult population of Tehran, Iran.From an urban community of Tehran, a random sample of 3400 adult men and women were selected by a cross-sectional design. Using the Persian version of the Pittsburgh Sleep Quality Index (PSQI), subjects were interviewed face-to-face. There were 3114 completed questionnaires returned and analyzed. The mean age of the subjects was 43.57 (± SD 17.5) years. Overall 37% (95% CI: 35–39) of the population were categorized as poor sleepers. The PSQI > 5 showed 27% were males versus 35% among females. The global PSQI scores ranged from 4.20 ± 2.67 to 5.60 ± 3.74 for males and 5.03 ± 3.00 to 7.97 ± 4.31 for females by age groups. The difference across age groups for global PSQI score was significant in females (P < 0.01).The prevalence rate of sleep complaints in this population-based study was high. Females, older adults, widows and separated couple were the most important risk factors for sleep disturbances.

Garlic is a plant with antimicrobial effects and different concentrations of garlic extract can decrease oral microorganisms. This study evaluates the effectiveness of different concentrations of garlic extract in an oral salivary microbial population.A total of 40 patients were selected based on information obtained through a questionnaire. Saliva samples were collected from all 40 subjects in dry plastic vials by spitting. Each sample was divided into 3 groups (2 cases and 1 control). One milliliter of sample was added to 9 mL of sterile physiologic serum and mixed. Then, this mixture was serially diluted to prepare a 10-3 suspension. One mL of garlic hydro-alcoholic extract was added to 1 mL each of the case specimens and transferred to a Trypticase Soy Agar (TSA) culture medium. Case specimens were exposed to 40% and 70% concentrations of garlic extract after 30 and 60 seconds. Control specimens were prepared by the same method, but without exposure to garlic extract. All samples were incubated at 37°C for 48 hours. Assessments were made based on colony counts to determine inhibitory activity of garlic extracts on oral salivary microorganisms.There was a significant reduction in colony forming unit (CFU) at 30 and 60 seconds for 40% concentrations of garlic extracts in comparison to the control group. In other words, 78% and 83.5% reduction in CFU, respectively. On the other hand, for the 70% concentrations, an 86.5% and 90.8% reduction occurred in CFU at 30 and 60 seconds, correspondingly.The mean colony counts of salivary microbial population at the 70% concentration were 771.72 ± 703.86 at 30 seconds and 524.8 ± 497.4 at 60 seconds.According to our findings, garlic extract is effective in the reduction of an oral microbial population.It may be useful as an alternative product and new treatment modality with fewer side effects.

World Kidney Dayon March 8th, 2012 provides a chance to reflect on the success of kidney transplantation as a therapy for end stage kidney disease that surpasses dialysis treatments both for the quality and quantity of life that it provides and for its cost effectiveness. Anything that is both cheaper and better, but is not actually the dominant therapy, must have other drawbacks that prevent replacement of all dialysis treatment by transplantation. The barriers to universal transplantation as the therapy for end stage kidney disease include the economic limitations which, in some countries place transplantation, appropriately, at a lower priority than public health fundamentals such as clean water, sanitation and vaccination. Even in high income countries the technical challenges of surgery and the consequences of immunosuppression restrict the number of suitable recipients, but the major finite restrictions on kidney transplantation rates are the shortage of donated organs and the limited medical, surgical and nursing workforces with the required expertise. These problems have solutions which involve the full range of societal, professional, governmental and political environments. World Kidney Day is a call to deliver transplantation therapy to the one million people a year who have a right to benefit.

Coronary arteriovenous fistulas are rare and may be congenital, traumatic, or iatrogenic. We report one of these rare congenital anomalies with a giant aneurismal right coronary artery (RCA) in a middle-aged lady who was asymptomatic for a long time.