Archives of Iranian Medicine
Volume:17 Issue: 8, Aug 2014

The aim of this study was to determine the frequency of each poisoning and its related death in our center as a sample of Tehran in six consecutive years (2006 to 2011). All poisoned children and adults referring to Loghman-Hakim hospital poison center and hospitalized in the study period were enrolled and evaluated. In 108,265 patients, the most common causes of poisoning were anti-epileptics and sedative-hypnotics (22.3%). The most common causes of death were pesticides (24.84%) and narcotics (24.75%). In drugs of abuse, opium was more prevalent in the early period of the study but was replaced by methadone later. It seems that national policies for drug control and prevention of suicide have not been efficient enough. We expect to see Iran in the first 50 countries with regard to suicide and to maintain the first place in narcotic abuse if enough attention is not provided.

The extensive rise in the prevalence of obesity is a matter of great concern and poses a global threat to people’s health. Obesity and overweight are considered to be the consequence of a collection of conditions including genetic, social, environmental, behavioral, and physical factors. The aim of this study was to investigate the determinants of weight change over seven years in a prospective study in an Iranian population. The Isfahan Cohort Study (ICS) is an ongoing longitudinal study started in 2001. A total of 6504 adults aged ≥ 35 years participated in this study. Subjects were followed every 2 years by phone calls. The interview and measurements were repeated in 2007 for 3284 subjects with the same protocol as the baseline study. Obesity indices, including body mass index (BMI) and waist circumference (WC) were measured at both time points. For the purpose of data analysis, multiple multinomial logistic regression, Chi-square, and ANOVA tests were used. In males, weight gain was more frequent from normal to overweight (11.7%), while in females, weight gain was observed more from overweight to obesity (11.4%). Younger individuals gained weight more than older individuals (P < 0.001); it was the same for lower education level (P = 0.007). Weight gain was negatively (OR: 0.98, 95% CI: 0.97–0.99 in male and OR: 0.96, 95% CI: 0.95–0.98 in female) and weight loss was positively (OR: 1.03, 95% CI: 1.01-1.05 in male and OR: 1.02, 95% CI: 1.01–1.04 in female) associated with age in both sexes. Education more than 12 years in women and between 6–12 years in men was negatively associated with weight gain while smoking was positively related to weight loss in females and weight gain in males. Our data showed that multiple factors affect weight change, among which age, smoking, and education are important determinants in Iranian adults.

Low testosterone levels in men have been associated with an increased risk of cardiovascular disease. We aimed to identify the association between serum testosterone level and premature coronary artery disease (CAD) and its predictors in young adult males. In this cross sectional study, consecutive male candidates for coronary angiography with unstable angina, no previous CAD and age ≤45 years were included. Serum levels of free (FT) and total testosterone (TT) as well as demographic and cardiovascular characteristics were compared between the CAD-positive and normal coronary subjects. The cutoff point for low TT was 2.5 ng/L. Additionally, the relationships between all the variables and the number of affected vessels and FT and TT and predictors of CAD were assessed. In this study, 191 patients with premature CAD were compared with 94 normal coronary subjects. Patients in the CAD group were significantly older (41.59 ± 3.79 versus 39.27 ± 4.97 years; P-value < 0.01), and had higher rates of diabetes mellitus (P-value = 0.04) and dyslipidemia (P-value = 0.01). Serum levels of FT and TT were significantly lower in the CAD group than the normal coronary subjects (P-value < 0.01 for both). The rate of subjects with low TT increased by the number of the affected vessels (p-value for trend <0.01) and there was a significant correlation between the Gensini score and FT and TT (r = -0.37, P-value < 0.01 and r = -0.34, P-value < 0.01, respectively). After adjustment for confounders, the association between low TT and CAD remained significant (Odds ratio = 4.30, 95% confidence interval: 1.99–9.32; P-value ≤ 0.001) Low levels of testosterone were associated with premature CAD and its severity in young adults.

BACKGROUNDd: The long-term results of coronary artery bypass surgery depend mostly on the type of the grafts. For a long time, it has been accepted that arterial grafts are superior to venous grafts. In this study, we evaluated the angiographic patency rates of arterial and venous grafts. The study took place between 2003 and 2013 in the Departments of Cardiovascular Surgery in Baskent University. The study included 52 patients with recurrent ischemic symptoms (of total 2183 coronary artery bypass surgery patients) following coronary artery bypass surgery. The patients were evaluated by control angiography during over mid- and long-term postoperative period (mean, 75.25 ± 35.15 months). Based on the angiographic findings, the grafts were divided into 3 groups: severe stenosis, moderate stenosis, and patent. The preoperative demographics (age, gender, hypertension or diabetes mellitus) were similar in the three groups. The mean numbers of distal anastomoses were 3.27 ± 0.89 (range 2–5), the degree of native coronary artery stenosis for radial artery anastomosis was 79.65 ± 17.72, and the mean numbers of radial artery and saphenous vein grafts were 1.19 ± 0.44 and 1.10 ± 0.89, respectively. The patency rate was 80.77%for radial arteries, 63.2% for saphenous veins, and 82.4% for left internal thoracic arteries in the three groups. The internal thoracic artery graft was confirmed to be the best option for aorta-coronary bypass surgery, as it has the highest patency rate compared to the other grafts. Radial artery and saphenous vein patency rate were also seen to be similar in the long-term.

Nephrotoxicity is considered a significant cause of patient morbidity following chronic Cyclosporine A (CsA) treatment. The exact mechanism of CsA-induced nephrotoxicity remains to be fully clarified. Tubulointerstitial fibrosis is widely regarded as a major pathway of CsA toxicity; therefore, the role of integrins as regulators of collagen in the extra-cellular matrix can be deemed pivotal. The objective of the present study was to observe the expression levels of alpha2beta1 integrin following CsA treatment +/- antioxidants. Adhesion assay, immunofluorescent and flow cytometric analyses were performed on kidney fibroblasts obtained from rats after administration of CsA (25 mg/kg/day) +/- Vitamin E (vit. E) and Quercetin (Q) for 4 weeks. Total RNA was collected from the aforementioned fibroblasts for semi-quantitative reverse transcriptase-polymerase chain reaction analysis of α2 and β1 integrins. We found that α2 and β1 integrins were both markedly reduced following treatment with CsA, i.e., 25% and 13%, respectively, but were normal following subsequent consumption of the antioxidants vit. E and Q. Attachment and spreading of the CsA-treated fibroblasts declined from 82% to 50%; however, this effect was partially reversed to 70% following antioxidant treatment. Similar results were observed in the spreading assay in which the level of spreading decreased from 73% to 21% and was subsequently restored to 46%. We conclude that cell adhesion, mediated by binding of integrin to collagen, which is a prerequisite of normal cell viability and collagen regulation, may be a novel pathway further explaining the nephrotoxic effects of CsA.

Recent evidence has indicated that polyunsaturated fatty acids (PUFA), such as omega-3 PUFA, have protective effects on a range of chronic inflammatory conditions, including obesity, and may play a role in the reversal of hepatic steatosis. However, the effects of omega-3 PUFA on adipokine expression and hepatic lipid metabolism have not been well evaluated. Thus, the aim of our study was to investigate the effects of PUFAs on adipokines, as well as lipid and glycometabolism, in a rat model of non-alcoholic steatohepatitis (NASH). Male Sprague-Dawley rats were divided into control, model and therapy groups. The control group received a normal diet, while the model and therapy groups received a high-fat diet. On the eighth week of high-fat diet, the therapy group was treated with omega-3 PUFA (1.0 g/d) daily. After 20 weeks, serum biochemistry indices were measured and adipokine levels in serum and liver samples were detected with ELISA, Western blotting and real time fluorescence quantitative PCR (qRT-PCR). The weight, biochemical parameters and adipokine levels in serum of the model group were elevated compared to the control group (P < 0.05). In addition, the protein and mRNA expression levels of adipokines in the liver were significantly altered compared to the control group (P < 0.01). The therapy group was characterized by decreased weight and biochemical indices (P < 0.05) compared with the model group. Supplementing high-fat diet with omega-3 PUFA decreased serum levels of leptin and resistin, while adiponectin levels were slightly elevated. In liver tissue samples, the protein and mRNA expression levels of adipokines were significantly improved (P < 0.01) in the therapy group compared to the model group. PUFA improved lipid and glycometabolism in NASH rats and regulated adipokine expression, indicating that omega-3 PUFA may have a therapeutic benefit for patients with NASH.

High blood glucose levels increase the ratio of phosphorylated to non-phosphorylated connexin-43 amounts, which leads to the decomposition of the hyperphosphorylated connexin-43. This can cause heart arrhythmia in diabetic patients. Considering the effective role of exercise in diabetic patients, and because there are few studies regarding the effect of exercise on phosphorylated connexin-43 protein levels, in the present study the impact of different periods of moderate regular exercise on phosphorylated Connexion-43 levels were examined. Sixty (60) male Wistar rats (300 ± 50 g) were randomly divided into six groups (n = 10). A week after induction of diabetes by injection of streptozotocin, one hour treadmill exercise, 5 days a week with 22 (m/min) speeds was undertaken. Left ventricles of hearts were isolated and immediately frozen. Finally, phosphorylated connexin-43 protein levels were measured by ELISA method. The means of blood glucose levels were significantly decreased (P < 0/05) by increasing days of exercise. The means of blood glucose levels were significantly decreased (P < 0/05) by increasing days of exercise. Regular moderate exercise reduced the connexin-43 levels by increasing days of exercise (P < 0.01). It is concluded that regular moderate exercise reduces the amount of phosphorylated connexin-43 protein levels in the ventricular myocardium, by reducing blood glucose levels. This can result in partial inhibition of cardiac arrhythmia observed in diabetic patients.

Lifestyle and dietary pattern in adolescence and young adulthood not only affect the general state of health in these years, but also leave long-term effects. Due to the importance of diet in youth, this systematic review summarized observational studies representing dietary intakes among Iranian adolescents and young adults. PubMed, Scopus and Web of Science databases were searched up to September 2013 using keywords related to diet, youth and Iran. Relevant papers were identified through applying a series of exclusion criteria in screening steps. Data were tabulated in 4 tables according to the level of assessed dietary exposure including energy or nutrients, foods or food groups, diet quality indices or dietary patterns, and dietary habits. Out of 1348 retrieved papers, 17 papers were eligible to enter this systematic review. Most studies were conducted in Tehran and Isfahan. Totally, 13113 individual were studied including 7327 girls and 5785 boys aged 10 to 28 years. Receiving lower or higher energy than required resulted in two burdens of malnutrition. Fiber intake was nearly half of the recommended amounts. Among micronutrients, calcium, phosphorus, folate and iron had the most common insufficient intakes. The youth consumed low whole grain, fruits, vegetables, dairy and unsaturated fatty acids and low diverse diet. Skipping breakfast was rife. Eating fast foods and unhealthy snacks was another prevalent inappropriate dietary habit. Dietary intakes and habits of young people are not favorable. Implementing informative programs and developing practical policies should be noted to improve the diet quality of adolescents and young adults.

Michelin tire baby syndrome is a rare syndrome, diagnosed clinically by multiple circumferential skin folds. Multiple noncutaneous anomalies have been described with this syndrome. We report a case of Michelin tire baby syndrome with congenital panhypopituitarism. To date, there is no report of association between these two disorders.

Virchow-Robin spaces are perivascular spaces that surround small arteries and arterioles as they enter the brain parenchyma. They are usually normal findings on MRI of healthy people. Rarely, Virchow-Robin spaces look strikingly enlarged, causing mass effect and unusual cystic conformations that may be misinterpreted as other pathologic processes, such as a cystic neoplasm. Here, we describe a 52-year-old woman in whom brain magnetic resonance imaging (MRI), performed to evaluate Parkinsonism, incidentally found giant Virchow-Robins space or Swiss cheese brain syndrome. In our patient, it seems that the giant Virchow-Robin spaces have been found incidentally and are not associated with the patient’s Parkinsonism symptoms.

Plastic bronchitis, causing airway obstruction, is a rare condition, especially in adults. In this paper, an adult male patient with heart failure, viral hepatitis, and a history of previous pneumonia, and expectorating white, plaque-like secretions for the last 6 months is presented along with the review of the relevant literature. The material expectorated by the patient was evaluated; macroscopically, this material was observed to be identical to the shape of bronchial branching. Steroid treatment was commenced after the diagnosis was established, resulting in the nearly total disappearance of the expectorated material.