Archives of Iranian Medicine
Volume:20 Issue: 3, Mar 2017

Mental disorders influence people with a high prevalence and exert remarkable burden on community members. This study was carried out aiming to assess mental health status within the age range category of 15 and above in the Islamic Republic of Iran.
The statistical population of this cross-sectional survey consisted of residents of urban and rural areas in Iranian provinces. An estimated sample size of 36000 people was chosen using systematic random sampling and the cluster method. Access was provided by the contribution of the Geographical Post Office for each province. The GHQ-28 was used as a screening tool for mental disorders. Data analysis was carried out using SPSS-18 software.
The results were gathered by the traditional scoring method. A total of 23.44% of samples were suspected of having mental disorders. The prevalence of suspicion for mental disorders was higher in urban (24.55%) than rural areas (20.89%). The prevalence of anxiety and somatization symptoms was higher than social dysfunction and depression symptoms. The outcomes also revealed that the prevalence of suspicion for mental disorders increased noticeably with aging. Suspicion for these disorders was more common in women, divorcees and widows, illiterates, less educated, unemployed and disabled individuals compared with other potential groups of the society.
Comparison of the outcomes from this study with the research conducted in 1999, demonstrated an increasing prevalence rate of suspicion for mental disorders. Therefore, it is mandatory for Iranian public health authorities to take the needed steps to ensure that necessary requirements encompassing prevention and promotion of mental health are implemented.

Various strategies are implemented to increase blood safety. However, there is always a small amount of residual risk. The amount of risk is associated with the incidence and prevalence of infection in the community. Since increases in the prevalence and changing the pattern of HIV transmission have been observed in the community, monitoring of HIV prevalence among general population and blood donors is necessary. This study aimed to determine the prevalence of HIV in Iranian blood donations. Demographic status and donation type were also investigated in HIV positive blood donors.
In the time frame of this study (2008 – 2013), the records of 11,504,231 donations were analyzed and all relevant data were extracted from the central database of the Iranian Blood Transfusion Organization. Demographic characteristics and type of donations were investigated. Descriptive and analytical statistics were used to summarize the obtained data.
A total of 421 blood donations were HIV sero-positive. Trends in HIV prevalence from 2008 to 2013 per 100000 donations were found as follows: 3.8, 4.3, 3.8, 3.8, 3, and 2.9, respectively. The average prevalence was 3.6 per 100000. The prevalence rate showed a fluctuation from 3.8 to 2.9 per 100000. Gradual reduction has occurred in HIV sero-prevalence but the difference is not statistically significant. The risk of HIV sero-positivity was higher in single and female blood donors. The prevalence of HIV was much higher among donations from first-time than from regular and lapsed donors.
The low prevalence rate of HIV in Iranian blood donations suggests the effectiveness of current safety strategies. However, implementing new strategies or improving the existing ones are advisable.

Both metformin and sulfonylurea (SU) drugs are among the most widely-used anti-hyperglycemic medications in patients with type 2 diabetes mellitus (T2DM). Previous studies have shown that treatment with SUs might be associated with decreased survival compared with metformin. This study aimed to evaluate all-cause and cardiovascular mortality rates between glyburide and metformin in patients diagnosed with T2DM.
This was a cohort study on 717 patients with T2DM (271 undergoing monotherapy with glyburide and 446 with metformin). Data were gathered from 2001 to 2014. All-cause and cardiovascular mortality were end-points.
During the follow-up, 24 deaths were identified, of which 13 were cardiovascular in nature. The group with glyburide monotherapy had greater all-cause mortality (17 (6.3%) in glyburide vs. 7 (1.6%) in metformin, P = 0.001) and cardiovascular mortality (11 (4.1%) in glyburide vs. 2 (0.4%) in metformin; P = 0.001). Metformin was more protective than glyburide for both all-cause (HR: 0.27 [0.10 – 0.73] P-value = 0.01) and cardiovascular mortality (HR: 0.12 [0.20 – 0.66], P-value = 0.01) after multiple adjustments for cardiovascular risk factors. Among adverse cardiovascular events, non-fatal MI was higher in glyburide compared to metformin monotherapy group (3.2% vs. 0.8%; P-value = 0.03), but not coronary artery bypass grafting (P-value = 0.85), stenting (P-value = 0.69), need for angiography (P-value = 0.24), CCU admission (P-value = 0.34) or cerebrovascular accident (P-value = 0.10).
Treatment with glyburide is associated with increased all-cause and cardiovascular mortality in patients with T2DM.

Burden of cancer is increasing in developing countries, where healthcare infrastructures and resources are limited. Evaluating the pattern of care would provide evidence for planning and improvement of the situation.
We studied the pattern of residential place and clinical information of cancer patients who were admitted to the Cancer Institute of Iran from January 1, to May 31, 2012.
We studied 1,705 consecutive cancer patients admitted to the Cancer Institute in the study period. The most common cancers were breast (29.2%), colorectal (9.0%), stomach (8.3%), head & neck (8.0%) and esophageal (3.8%) cancers. Radiotherapy was the main treatment (52.1%) followed by chemotherapy (43.8%) and surgery (29.1%). We found that 60% of the patients presented in the loco-regional or advanced stages. About 35% of patients travelled from other provinces mainly from Mazandaran (13.4%), Lorestan (10.6%), Zanjan (7.8%) and Ghazvin (6.6%). On average, the cancer patients travelled about 455 kilometers to receive care in the cancer institute. We found more than 38% patients who were referred from other provinces had an early stage tumor.
Establishment of comprehensive cancer centers in different geographical regions and implementation of a proper referral system for advanced cancer patients is needed to improve the patient outcomes and mitigate the burden of travel of patients for cancer care.

Recent genome-wide association studies (GWAS) in European populations have indicated that the rs12526453 polymorphism located in phosphatase and actin regulator 1 gene (PHACTR1), mapping to chromosome 6p24 and rs7865618 polymorphism in the cyclin-dependent kinase inhibitor B antisense RNA 1 gene (CDKN2B-AS1) on 9p21.3 are associated with coronary heart disease (CHD). This study was carried out to investigate the association of these polymorphisms and CHD in an Iranian population.
In the present case-control study, 420 patients with CHD events were recruited from the population of the Tehran lipid and glucose study (TLGS); 407 healthy controls matched for age and sex were selected from the same population. The SNPs rs12526453 and rs7865618 were genotyped using amplification refractory mutation system-polymerase chain reaction (ARMS-PCR).
The allele frequency of both SNPs deviated from Hardy–Weinberg equilibrium. The C allele frequency of the rs12526453 (68.5%, P = 0.11) and A allele of the rs7865618 (68.8%, P = 0.09) were the most prevalent alleles in both the case and control groups. The results indicated a significant association between the presence of risk alleles of rs7865618 and CHD in the TLGS population (P = 0.03; OR: 1.73; CI95%: 1.04 – 2.88)
Due to the importance of chromosome 9p21 region and its relation with cardiovascular disease, the allelic pattern of its variation should be studied in different populations. The relation between this polymorphism and cardiovascular disease in the studied population confirms the importance of this region.

Non-invasive ventilation (NIV) has brought about a significant change in care and treatment of respiratory distress syndrome (RDS) in very low birth weight (VLBW) neonates. The present study was designed and conducted to evaluate different strategies of initial respiratory support (IRS) in VLBW neonates hospitalized in the neonatal intensive care unit (NICU).
This prospective study was conducted over three years (March 21, 2011 to March 20, 2014). Each eligible VLBW baby with RDS diagnosis received a specific IRS, including room air (RA), oxygen therapy (O2 RX), n.CPAP, NIPPV, MV ± SURF, based on clinical evaluation; then, the next strategies were selected based on the disease progression. Obtained data was entered in SPSS and the groups were compared for disease consequences or death. Then, contributing factors to the failure of NIV strategies, and the need for endotracheal mechanical ventilation (eMV) were determined.
In total, 499 neonates were included in the study. The mean birth weight was 1,125 ± 254 g and the gestational age was 29.2 ± 2.5 weeks. The IRS included: RA = 43, O2.RX = 60, n.CPAP/NIPPV = 219, INSURE = 83 and MV ± SURF = 177. In terms of the need for IRS upgrading during hospitalization, neonates not on mechanical ventilation (64.5%) were divided into three groups. In 45.3% of cases, the IRS did not change (Never upgrading); in 24.5% of cases, the level of IRS increased but there was no need for eMV in the first three days of life (Specific); in 24.8% of cases, there was need for eMV within the first three days of life (Absolute) and during hospitalization (after the first three days of life) 5.3% of cases were in need of eMV (General).
In terms of correlation between the effective variables in IRS upgrading, univariable analyses showed that low gestational age, low birth weight, multiple pregnancy, maternal disease, low one-minute Apgar score, and need for surfactant therapy had significant correlation, and multivariable analysis showed that low gestational age, low birth weight and maternal disease were risk factors independently correlated to IRS upgrading, CLD and death.
Early use of NIV in preterm neonates with mild to moderate respiratory distress and spontaneous breathing significantly reduced the need for intubation, surfactant, mechanical ventilation and thereby pulmonary and non-pulmonary complications and neonatal mortality.

Expression of miR-122 is highly specific to hepatocytes of the liver. This miRNA is involved in lipid hemostasis of the tissue; however, there is no comprehensive understanding of its function in lipid hemostasis.
Since hepatocytes are responsible for part of Triacylglycerol (TAG) synthesis in the body, we hypothesized that miR-122, as the most abundant miRNA in the tissue, might regulate TAG metabolism by targeting key enzymes that are involved in its production pathway. A systematic computational analysis of putative targets of miR-122 identified CTDNEP1 and LPIN1 genes in the TAG pathway. We used dual-luciferase reporter assay, quantitative RT-PCR as well as western blot to confirm the repressive effect of miR-122 on CTDNEP1 and LPIN1 in TAG pathway.
Real time PCR on liver needle biopsies with hepatosteatosis showed that miR-122 is up-regulated in hepatosteatosis. Surprisingly, the protein and RNA level of identified targets of miR-122 are also up-regulated in clinical samples, probably as a disproportionate feedback response to the high level of miR-122.
Our findings suggest that up-regulation of miR-122 can trigger the compensatory response of LPIN1 and CTDNEP1 in hepatosteatosis.

With the development of neonatal intensive care units (NICUs), new issues have emerged for physicians working in this area, including the ethical aspects of providing invasive and advanced care to neonates with extremely poor prognosis. This research was undertaken with the aim of investing the factors affecting physicians’ practice in management of newborns in such complicated circumstances.
A cross-sectional study was carried out over a period of 5 months (Jan 2012 to Jun 2012) in 9 different tertiary levels and academic NICUs affiliated to Tehran University of Medical Sciences in Tehran, Iran. Checklists related to management of 3 hypothetical cases with very poor prognosis and factors affecting pertinent decisions were administered to 88 neonatologists and pediatricians.
Totally, 81.4% of participants approved the use of advanced invasive methods of treatment in the premature neonate. Concerning the neonate with genetic malformations, 51.3% recommended advanced methods. In severe asphyxia, 42.1% disagreed with use of advanced invasive procedures. Overall, 34.2% of the target physicians approved the use of aggressive procedures in all 3 cases. Age, gender, marital status, parental status, and work experience were identified as influencing factors.
With the prediction of acceptable levels of survivability in very premature infants, physicians are more inclined to treat this group. However, they do not favor aggressive measures in infants with severe asphyxia and advanced anomalies.

Consanguinity (when couples share at least one common ancestor) is a public health issue with a variety of distributions and incidence rates worldwide. Several epidemiological studies have explored the association between consanguinity and low birth weight (LBW). However, the results are inconsistent. This meta-analysis aimed to explore the overall association between consanguineous marriage and LBW.
We searched PubMed, Web of Science, Scopus, ScienceDirect, and reference lists of articles up to May 2015. We included cohort, case-control, and cross-sectional studies addressing the association between consanguinity and LBW. We assessed heterogeneity using Q-test and I2 statistic. We explored publication bias using the Egger's and Begg's tests and the funnel plot. We meta-analyzed the data and reported the overall odds ratio (OR) and mean difference with 95% confidence intervals (CI) using the random-effects model.
We included 24 out of 3941 retrieved studies, with 44,131 participants. We indicated that LBW was associated significantly with first-cousin marriages (OR = 1.36; 95% CI: 1.03, 1.69) and non-significantly with second-cousin marriages (OR = 1.20; 95% CI: 0.49, 1.91). Furthermore, first-cousin marriages can reduce the birth weight of siblings of consanguineous couples 144 g more compared to non-consanguineous marriages.
This meta-analysis measured the association between consanguinity and LBW. Based on the current evidence, consanguineous marriage can increase the risk for LBW. However, further evidence based on large cohort studies conducted in different settings is required to make a robust conclusion regarding the effect of consanguinity on LBW.

Some studies have indicated a close relation between serotonergic and cannabinoidergic systems in several brain regions. Thus, the aim of current study is investigating the effect of 5-HT1 receptors of accumbens shell (Acb shell) on aversive memory deficit induced by ACPA (cannabinoid CB1 receptor agonist) using test-retest protocol of elevated plus-maze (EPM) in male Wistar rats.
Bilateral guide cannulae were implanted to allow microinjection of ACPA, CP94253 HCL (5-HT1 receptor agonist agonist) or GR127935 HCL (5-HT1 receptor antagonist).
Post-test intra-Acb shell of ACPA (0.002 μg/rat), CP94253 (0.5 and 5 ng/rat) and GR127935 (5 ng/rat) increased the percentage of open-arms time (%OAT) in the EPM task compared to the control group, indicating aversive memory deficit. Moreover, concurrent microinjection of the subthreshold dose of CP94253 and GR127935 into Acb shell did not alter open-arms exploratory behavior induced by intra-Acb shell of ACPA on the retest day.
Our data suggests that Acb shell 5-HT1 receptor does not affect aversive memory deficit induced by ACPA in the Acb shell.

The subject of this paper is the story of an ancient medical instrument. This instrument is a wooden vaginal speculum used in classical and Islamic medicine. Its drawings can be found in Abulcasis al-Zahrawi’s and Şerefeddin Sabuncuoğlu’s illustrated books of surgery.