Archives of Iranian Medicine
Volume:18 Issue: 1, Jan 2015

The fertility behavior of Iranian women and their reproductive needs is changing and consequently, for providing good services, it is critical to monitor their reproductive behavior at a national level. This study was carried out by Avicenna Research Institute in the urban and rural parts of Iran between 2010 and 2011. Using cluster sampling, the reproductive history of 17,187 married women aged 20 – 40 years were recorded. The statistical analysis of the data was performed using SPSS software (Version 11.5), and P < 0.05 was considered significant. The common methods of contraception at the time of interview were natural methods (29.8%). The first pregnancy was unwanted in 20.6% of the women. The average number of childbirth per 35 – 40 years woman was 2.4. The mean age of women at marriage date and the mean age at the first childbirth both have increased with time (p< 0.001). Although the fertility rate has declined in Iran, the most important reproductive issues like unwanted pregnancy and use of non-reliable methods of contraception are not resolved yet. Increased mean age at first Childbirth and elevated numbers of couples with no childbirth, because of voluntarily childlessness or Infertility should be noticed more by policy makers. Then allocating enough resources for reproductive health services is vital in new family planning policies.

This study aims to identify morphological changes in the lung parenchyma of acute respiratory distress syndrome (ARDS) survivors after extracorporeal membrane oxygenation (ECMO) by high-resolution computed tomography (HRCT) follow-up. Factors influencing these changes are also examined. Information and lung HRCT scans were collected and studied 1, 3, 6, and 12 months after the withdrawal of severe ARDS survivors rescued by ECMO in the Respiratory Care Unit of Beijing Chaoyang Hospital from November 2009 to August 2012. The observation endpoint was set as the time when the lung lesions were basically absorbed or 12 months after withdrawal. Among nine survivors, one survivor was lost to follow-up. The lesions of two patients, which were attributed to bacterial pneumonia and pneumocystis pneumonia, were basically absorbed 1 month after surgery. Six patients completed the 12 month follow-up. Although initial morphological changes varied, different degrees of absorption improvement were observed in later stages of treatment. Lung HRCT analysis on the sixth month indicated that the degree of involvement of the ventral region was greater than that of the dorsal area. No significant difference was observed in patients in terms of ECMO support time, pre-ECMO Murray score, and APACHE II score, among others. Lung HRCT of severe ARDS survivors after ECMO treatment showed various degrees of morphological changes in the lung parenchyma. The severity of these changes may be associated with the disease duration.

Regulation of reproduction is now considered to be carried out by the kisspeptin and its receptor, GPR54 or Kiss1r. Mutations of either Kiss1 or Kiss1r in humans and mice result in profound hypogonadotropic hypogonadism. The present study was aimed to determine whether the levels of kisspeptin are associated with male infertility. The study involved 176 male subjects aged 18 – 50 years including 26 fertile and 150 infertile. Infertile subjects were further subdivided according to WHO guidelines of semen analysis into 22 asthenozoospermia, 08 asthenoteratozoospermia, 18 azoospermia, 58 normozoospermia, 06 oligozoospermia, 12 oligoasthenozoospermia and 26 oligoasthenoteratozoospermia. Thorough clinical examinations excluded those suffering from chronic health problems. Serum kisspeptin levels were measured by enzyme immunoassay (EIA) and follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone were estimated by chemiluminescence assay (CLIA). The results of the present study have revealed that kisspeptin levels were significantly lower in all infertile males as compared to the fertile males. Significantly low LH and testosterone levels were observed in all infertile groups as compared to fertile group. FSH levels were significantly lower in normozoospermic and azoospermic as compared to fertile males, while no significant difference was observed between the other infertile and fertile group. The study revealed that serum kisspeptin levels were observed significantly lower in the infertile as compared to fertile males, indicating that the kisspeptin might be associated with the fertility problems in males.

Iranian propolis is a natural product of honeybees that has significant and varied anti-cancer benefits. The present study was designed to investigate the protective effects of Iranian propolis on gastric tissue carcinogenesis in an animal model. Propolis samples were collected from Hamadan and Taleghan districts of Iran, followed by ultra performance liquid chromatography mass spectrometry analysis. Fifty-five rats were divided into three groups; control, Taleghan propolis and Hamadan propolis. All the animals received N-methyl-N-nitro-N-nitrosoguanidine (MNNG, 100 μg/ml) in drinking water ad libitum for 34 weeks. In the treated groups, nutrition with propolis was started two weeks before MNNG administration. At the end of the study, the entire gastrointestinal tract was scrutinized for tumors, and the rest of the body was assessed for metastatic deposits. Results indicated that the incidence and number of tumors were significantly decreased by propolis in comparison with the control group (P < 0.05). The nuclear/cytoplasmic ratio, epithelial stratification, nuclear dispolarity, structural abnormality, and Beta-catenin and Bcl-2 proteins expression were significantly reduced in the propolis group compared to the control group (P < 0.05). In addition, Bax protein expression was significantly increased in the propolis group in comparison with the control group (P < 0.05). The present study demonstrated the potential chemoprotective effects of the Iranian propolis against gastric cancer in a typical animal model. The results provide evidence for the hypothesis that Iranian propolis may exert a chemoprotective effect on MNNG-initiated gastric cancer through inhibition of cell proliferation and apoptosis induction.

The main strategy in inguinal hernia repair is mesh hernioplasty (specially prolene mesh). Pain in anterior femoral, inguinal and scrotal areas, mainly due to sensory nerve injury in the very regions and vas deferen injury are the main complications reported following repairing inguinal hernia. In this study we decided to use semiliquid silicone in order to form it in an in-vivo prosthesis production method to perform hernioplasty. In this technique, silicone was produced through Room Temperature Vulcanization (RTV) technique, which is feasible in the room temperature. The produced semiliquid polymer was shaped in the inguinal canal in six cadavers. While the prostheses adequately covered all the anatomic area of the canal with an acceptable thickness in all of the cases, a satisfactory shape was developed in four cases. While 15 – 20 cc of silicone was needed to cover all anatomic areas properly, the hardness equal to 15 was achieved after curing process. New silicone prosthesis forms satisfyingly in the inguinal canal and can protect it by encapsulation mechanism. It is soft with no risk of damage to the nerves or vas. It is inert and has no toxicity to the adjacent tissue. This technique of silicone remodeling can also be used in other fields of surgery such as plastic or vascular surgery.

Preclinical studies and early pilot clinical investigations have suggested that N-acetylcysteine (NAC) may be useful in treatment of methamphetamine (METH) dependence. The present study evaluated whether NAC would suppress craving to the METH. In a double-blind, controlled crossover clinical trial, 32 METH-dependent volunteers were chosen to receive either NAC (1200 mg/day) or placebo, randomly. They were intervened in two four-week sessions. During first session they received either 1200 mg/day of NAC (group A) or placebo (group B). After three days of washout period, next session started with the crossover intervention of the previous regimen. During these eight weeks, all participants received standardized, and Matrix Model of treatment. Craving was assessed using the Cocaine Craving Questionnaire-Brief (CCQ-Brief). The data were analyzed using SPSS version 20.0 (SPSS Inc. Chicago, Illinois, USA). In 23 subjects who completed the study, the mean score of CCQ-Brief reduced in four consecutive weeks with NAC treatment. The mean (SD) scores of carving in group A and B were 3.38 (1.16) and 5.96 (1.03), at the end of first session; and 4.57 (1.88) and 3.2 (0.86), at the end of the second session, respectively. Our findings indicate that the main effect was significant for NAC (P < 0.001). Across placebo and NAC conditions, only mild side effects were noted, and the number of subjects who reported side effects did not differ. The NAC showed good efficacy in suppressing METH craving, and may be a useful pharmacological treatment for METH dependency.

Hepatitis B virus infection is one of the most common causes of acute and chronic hepatitis worldwide. Furthermore, since most people with hepatitis B virus are asymptomatic, timely diagnosis is important for prevention. This study has evaluated the prevalence of Hepatitis B seromarkers in marriage candidates.DESIGN: In this Cross-sectional study, 370 marriage volunteers selected by the simple sampling method were investigated in 2011 – 2012. A total of 185 men and 185 women were investigated. Mean Age of participants was 24.7 years. The prevalence rates of hepatitis B surface antigen (HBsAg), anti hepatitis B surface antibody (anti-HBs) and anti-hepatitis B core antibody (anti-HBc) were 1.1%, 47.6% and 8.9% respectively. Frequency of HBsAg was 0.5% and 1.6% in men and women respectively. The prevalence of anti-HBs was 43.8% in men and 51.45% in women. Anti-HBs was more common in young people and those with higher levels of education and positive history of vaccination. The prevalence of anti-HBc was 8.1% and 9.7% in men and women respectively. Although Kerman is a low endemic area, due to the high risk of transmission to the spouse and offspring, screening for HBV study before marriage is recommended.

The investigations on suicide conducted within low- and middle-income countries are limited. This study evaluated the trend of suicide and its associated risk factors in the west of Iran. This six-year population-based survey was conducted in Kermanshah Province, in 2012. The data on suicide was extracted from the suicide database of the Provincial Health Center, which was collected for six successive years. Multivariate logistic regression analysis was performed and odds ratio (OR) as well as its 95% confidence intervals (CI) was reported. During the study period, 13,810 attempted suicides occurred of which 1,564 (11.33%) were completed. The incidence rate of suicide has increased in recent years. Based on logistic regression analysis, OR estimate of completed suicide increased 1.46 (95% CI: 1.36, 1.56) fold for every 10-year increase in age. Moreover, OR estimate of completed suicide was 2.53 (95% CI: 1.94, 3.31) in men compared to women. Compared to married people, the OR estimate of completed suicide was 1.41 (95% CI: 1.15, 1.72) in single people, 1.92 (95% CI: 1.15, 3.23) in widowed people, and 1.97 (1.32, 2.95) in divorced people. The lower the educational level, the higher the risk of completed suicide. Compared to school/college students, the risk of completed suicide was higher among housewives, employed people or employees, and retirees. A majority of the suicides (90.05%) occurred at home. Taking medications was the most common way (69.13%) of a suicide attempt. We indicated that associated factors with completed suicide vary in Iran compared to other developed and developing countries and that factors associated with attempted suicide are different from that of completed suicide.

PCR can overcome the limitations of conventional detection methods. The aim of this study was to evaluate three primer pairs broadly used B4/B5, F4/R2 and JPF/JPR, for detection of Brucella by PCR, in human and animal serum samples and to determine analytic sensitivity of primers. Total of 68 serum samples were collected in acute phase of brucellosis. 10-fold serial dilutions were prepared from bacterial suspension and serum suspension using Brucella abortus S19. DNA was isolated using boiling. The best dilution from DNA was determined for PCR with three primer pairs. PCR was performed using primer pairs on all bacterial dilutions, serum dilutions, 1/200 dilutions and serum samples. Comparison of sensitivity between three primer pairs was performed with statistical analysis. The best DNA dilution was 1/200. From 68 serum samples, 54 cases (79.41%), 44 cases (64.70%) and 35 cases (51.47%), were positive by PCR with B4/B5, F4/R2 and JPF/JPR respectively. B4/B5, F4/R2 and JPF/JPR were able to identify 9 × 102, 9 and 9 × 10 5 bacteria in 1ml of bacterial suspension and 9 × 10 4, 9 × 10 5 and 9 × 10 7 bacteria in 1ml of dilution 1/200 of Serum dilutions respectively. The differences between primers by statistical analysis were significant for human, animal and total samples. No band was observed in dilutions 1 of DNA isolated from serum. So, to decrease the effects of inhibitors, DNA was diluted. When DNA isolation is boiling, F4/R2 and B4/B5 have the greatest sensitivity for purified bacteria and serum in detection of Brucella respectively. DNA isolation by boiling can decrease the PCR costs.

Fast-growing epidemic of chronic diseases causes many health challenges over the world. Regarding reported pros and cons, the aim of the current study is to review the effect of nutrition and physical educational intervention in decreasing cardiovascular risk factors. METHODS & MATERIALS: In this review study, searching has done through the English and Persian databases. Articles with other languages, lack of important information, and score 3 or less in the JADAD standard checklist were exluded from the study. In the primary search, 194 articles have been found, Through four stages of secondary search and further evaluation, 43 articles were selected. These articles were published between1989 to 2013. According to these findings, the majority of articles showed a positive effect of nutrition and physical activity educational interventions on cardiovascular risk factors- blood cholesterol, systolic and diastolic blood pressure, as well as smoking cigarette in high risk patients. These results, suggest the necessity of continiuting nutrition and physical educational intervention for individuals with cardiovascular risk factors.

This report presents a case of dynamic ulnar tunnel syndrome due to an additional origin of abductor digiti minimi muscle (ADMM) from the palmaris longus tendon. Patient’s symptoms resolved after excision of the aberrant muscle.

Mutations in plectin, a widely expressed giant cytolinker protein can lead to different diseases mostly with signs of muscular dystrophy (MD) and skin blistering. The only report of plectin-related disease without skin involvement is limb-girdle muscular dystrophy type 2Q (LGMD2Q) phenotype, showing early-onset limb-girdle muscular dystrophy symptoms with progressive manner and no cranial muscle involvement. Here, we report a non-consanguineous Iranian family with two affected sisters showing progressive limb and ocular muscle weakness. Whole Exome Sequencing (WES) led to identification of a compound heterozygous mutations, p.Gln1022Ter (c.3064C>T) and p.Gly3835Ser (c.11503G>A), in PLEC gene. To the best of our knowledge, this would be the first report of a patient with LGMD and myasthenic symptoms without any skin involvement, caused by plectinopathy. This observation extends the phenotypic spectrum of PLEC related diseases and suggests a variable expression of the PLEC- related symptoms.

Chronic myelogenous leukemia (CML) and tuberculosis (TB) are diseases with effective available therapy. Treating patients who are afflicted simultaneously with both of these conditions is challenging due to significant drug interactions and the requirement of strict adherence to the multi-agent treatment regimen. Here, we report a case of peritoneal tuberculosis which was successfully treated with a non-rifampin based regimen in tandem with ongoing administration of a tyrosine kinase inhibitor, dasatinib, for CML. We discuss treatment challenges and the strategy on how to circumvent them. As prevalence of CML increases worldwide, patients with concomitant CML and TB will be seen more often by physicians in all continents, and development of guidelines on simultaneous management of these conditions is imperative.