Archives of Iranian Medicine
Volume:19 Issue: 1, Jan 2016

The burden of inflammatory bowel disease (IBD) hasn’t been reported in Iran. We aimed to estimate the prevalence and incidence of IBD and its trend in Iran at national and subnational level from 1990 to 2012. We conducted a systematic review of English and Persian databases about the epidemiology of IBD. We also collected outpatient data from 17 provinces of Iran using almost all public and private referral Gastroenterology clinics. Prevalence and incidence rate was calculated at national and subnational levels. The Kriging method was used to extrapolate provinces with missing data and GPR model to calculate time trends of rates at subnational level. We found 16 case series, two population-based studies, and two review articles. We collected 11,000 IBD cases from outpatient databases. Among them, 9,269 (84.26%) had ulcerative colitis (UC), 1,646 (14.96%) had Crohn’s disease (CD), and 85 had intermediate colitis (IC). A total of 5,452 (49.56%) patients were male. Mean age at diagnosis was 32.80 years (CI: 13 – 61) for UC and 29.98 years (CI: 11 – 58) for CD. Annual incidences of IBD, UC, and CD in 2012 were 3.11, 2.70, and 0.41 per 100,000 subjects respectively. Prevalence of IBD, UC, and CD in 2012 were 40.67, 35.52, and 5.03 per 100,000 subjects respectively. The incidence of UC and CD showed a significant increase during the study period (P for trend < 0.05). The incidence and prevalence of IBD are increasing in Iran. Establishing a national IBD registry seems necessary for comprehensive care of IBD patients in Iran.

In the 1980s, PHC implementation promoted the health care delivery and overall health status of the population in Iran. Identifying the crucial design and implementation aspects of the PHC program can highlight the way it was implemented in a difficult sociopolitical environment. Using a policy analysis approach unfolds the details of implementation in a context which was not overtly convenient for a great health system reform. We conducted semi-structured interviews with 35 key participants and collected relevant literature and documents. We used a policy triangle framework to conceptualize the study and used a thematic data analysis approach to analyze the verbatim transcribed texts and documents. Data were analyzed with regard to the context, content, process and actors of the policy. Proper use of the conditions and opportunities, during the first years after a revolutionary political change resulted in the establishment of a PHC network in Iran. Talented actors, clear content with agreed objectives and a top-down approach to the implementation in a special sociopolitical context were the main influential factors to fulfillment of the PHC policy in Iran. However, full implementation of the policy was hampered by the failure of some main components like referral system. The policy triangle framework helped us to separate the different components of the PHC policy denoting that successful implementation of a policy requires attention to all related elements. Policy actors should invest in the development of an effective advocacy coalition, while giving ample attention to the implementation concerns. National health policies can be materialized even during financial hardships, if they align with the wider expectations of the public and politicians.

Sodium selenite and ginsenoside Rh2 (G-Rh2) are well known for their anticancer properties and have been exploited as a new therapeutic approach. In this study, we are interested to evaluate if sodium selenite and G-Rh2 combination results in a synergistic anticancer effect that could contribute to lower systemic toxicity. We observed the synergistic antitumor effect by combination of sodium selenite and G-Rh2 on HCT-116 human colorectal carcinoma cells in vitro. Cell growth, viability, cell cycle progression and cell apoptosis, Bax/Bcl2 ratio, caspase-3 expression, reactive oxygen species (ROS) production and autophagy were evaluated. The results showed that sodium selenite and G-Rh2 combination have a synergistic effect on cell growth inhibition (57%) compared with sodium selenite (25%) and G-Rh2 alone (28%) after 24hours of treatment. This combination also induced G1 and S phase arrest simultaneously and increased apoptosis rate. The results also indicated that Bax/Bcl2 ratio and caspase-3 expression, known as proapoptotic factors, were increased in the presence of sodium selenite and G-Rh2 alone. However, combined drug treatment results in a more significant increase in Bax/Bcl2 ratio and caspase-3 expression (P < 0.05). In addition, this combination significantly induces a depletion of ROS production and autophagy, compared to control, sodium selenite and G-Rh2 alone (P < 0.05). Sodium selenite and ginsenoside Rh2 combination may be a more effective treatment for human colorectal carcinoma and is a promising chemotherapeutic approach for malignant tumors.

Solid-pseudopapillary tumor (SPT) of the pancreas is a rare tumor, generally characterized by a well-encapsulated mass. The aim of the current study was to analyse the clinicopathological characteristics and treatment outcomes of patients with SPT. In this study, we report our clinical experience with 16 cases of SPTs. Sixteen patients who underwent surgery for pathologically confirmed SPT were included. Data of the patients were reviewed from the prospectively recorded database. Patients’ demographics, laboratory values, clinical presentation, radiological imaging findings, surgical treatment, perioperative complications, pathological features, post-operative course, and long-term survival were collected and analyzed. Statistical analyses were performed using the computer program Statistical Package for Social Sciences (SPSS) 16.0 for Windows. The tumors ranged from 2 to 11 cm in diameter and were located in the head in ten patients (62.5%), the neck in two patients (12.5%), and the body or tail in four patients (25%). All patients were women whose ages ranged from 21 to 79 years (mean age was 41.62 ± 15.08). Patients had resection margins free of tumor resections and there were no preoperative or postoperative mortalities. There was no recurrence or metastasis after the surgical resection. All patients were alive at a mean follow-up of 49.06 ± 29.53 months (range 6 to 99). SPT is a rare pancreatic neoplasm with a low malignant potential, and is common in young women. If SPT is diagnosed before surgery, complete surgical resection, generally enucleation is the most effective therapy for SPT.

Non-secretor individuals lack ABO blood group antigens in their secretions like saliva; these carbohydrate structures play an important role in protection of the oral cavity from exogenous pathogens; therefore these individuals are more susceptible to mucous membrane damages. The aim was to assess the secretory state of patients with oral lichen planus (OLP) in comparison with healthy controls. Fifty patients and 100 age-gender matched control subjects were recruited to the study. Patients were visited in the outpatient clinic of dermatology at Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences from 2012 – 2014. Two-milliliter (mL) blood was collected from each subject to detect Lewis phenotypes. According to Lewis phenotype of each subject, secretory state was determined except in subjects with Le (a-b-) phenotype, in whom saliva was collected to determine the secretor status. Non-secretor status in patients with OLP was more frequent compared with healthy controls (37 out of 50 patients (74%) vs. 24 out of 100 healthy controls (24%), (P < 0.001)). There was no association between secretory state, and type of OLP and disease duration (P > 0.05). This study supported the possible role of cell surface histo-blood group antigens in protection of mucosal surface from exogenous pathogens. Therefore, it appears that non-secretor individuals are more prone to oral lichen planus.

The present study is a utilization review of outpatient services offered by specialists and underlying social factors among urban families in Fars Province, Iran. The present study conducted among 1900 residents in urban areas of Fars Province in January 2013. Sampling was carried out through a three-step method, which was designed based on utilization of health services survey. Data were analyzed using statistical tests. About a quarter of the sample group expressed the need for outpatient services of specialists, of whom about 83% received medical attention of a specialist. Among the main reasons for not referring to specialists were financial issues as the top reason followed by refusal to visit the physician, long distances and high costs of the services. About 17% of the participants who needed outpatient services of specialists failed to receive the service. This indicates the necessity of measurements to improve the access to outpatient services of specialists among different social groups.

Metabolic syndrome (MetS) is a multi-factorial disorder with five important components. A high triglyceride level combined with low HDL cholesterol has been reported to be associated with Apolipoprotein A5 (APOA5) gene variations. In this study, we aimed to determine the association of single nucleotide polymorphisms including: rs662799, rs3135506 and rs2075291 in the apolipoprotein A-V (APOA5) gene in relation to MetS component like triglyceride and HDL-C level in Tehran Lipid and Glucose Study (TLGS). Metabolic syndrome was defined according to ATPIII and phenotypes were defined by the National Cholesterol Education Program (NCEP) criteria for MetS. Demographic, biochemical parameters and anthropometric variables were measured. Selected APOA5 gene polymorphisms were genotyped using PCR-RFLP method. From TLGS population, 947 adults, aged 19 – 70 years, were randomly selected and recruited into the study. Mean age, triglyceride and WC were higher and mean HDL was lower in MetS vs. non-MetS group. C allele in rs2075291 showed a significant association with MetS (OR: 2.38, 95% CI; 1.11 – 5.08, P = 1.5 ×10-2). The association was shown between higher serum triglyceride and the presence of T allele (P = 4.5 × 10-4) and also lower serum HDL-C and the presence of T allele (P = 1.6 × 10-3) in rs2075291. Also this association showed between raised waist circumference and C allele in rs3135506 (P = 3.5 × 10-2) and raised systolic and diastolic blood pressure level and C allele of rs662799 (P = 4.5 10-2). According to the results, there is a relationship between lipid profile and studied polymorphism in the presence of metabolic syndrome. It seems that APOA5 rs2075291 could play an important role in triglyceride and HDL-C level in metabolic syndrome affected, while the association of APOA5 rs662799 polymorphism is still under debate.

The internalizing and externalizing problems relating to childhood and adolescent have always been significant. Because there is special considerations in establishing communication with them and hence, the therapeutic methods for these problems must take into account these considerations. As establishing a therapeutic relationship is an important component of effective counseling, it seems that art therapy may help alleviate these problems. The purpose of this study is to determine the effectiveness of art therapy in reducing internalizing and externalizing problems of adolescent girls (14 – 18 years old). This is a semi-experimental study carried out in the form of a pre-test/post-test design with control group. The population of this study includes female students of Gole Laleh School of Art in district 3 of Tehran, Iran, out of which 30 students with internalizing problems and 30 individuals with externalizing problems were selected through targeted sampling. Students were randomly assigned to control and experimental groups. Experimental groups participated in 6 painting sessions designed based on Art therapy theories and previous studies. The material used for diagnosis of the problems in posttest and pretest was an Achenbach self-assessment form. Data were analyzed using a mixed analysis of variance (ANOVA). Our results showed that Art therapy significantly reduced internalizing problems (F = 17.61, P < 0.001); however, its effect in reducing externalizing problems was not significant (F = 3.93, P = 0.06). Art therapy as a practical therapeutic method can be used to improve internalizing problems. To reduce externalizing problems, more sessions may be needed. Thus, future studies are required to insure these findings.

To evaluate the outcome of laparoendoscopic single-site (LESS-A) through one transumbilical port vs. 3-port laparoscopic (3TA) appendectomy in children. We reviewed the records of 309 children (65 LESS-A, 244 3TA) operated on between 2008 and 2012. One hundered forty-nine patients had acute catarrhalis (CA), 133 phlegmonous (PLA), and 27 perforated appendicitis (PA). We compared the duration of operation (DO) the incidence of abdominal abscesses (AA)and wound infections (WI), as well as the degree of appendiceal inflammation (DI) among surgeons with and without board certification. For all DI, LESS-A resulted in a shorter DO than 3TA (CA 57.9 ± 22.8 vs. 68.5 ± 23.2, P = 0.014; PLA 51.5 ± 16.5 vs. 68.4 ± 33.0, P = 0.006; PA 66.0 ± 29.0 vs. 97.3 ± 41.8, P = 0.039). LESS-A was not used for less complicated cases when compared to 3TA (CA 50.8% vs. 47.5%; PLA 33.8% vs. 45.5%; PA 15.4% vs. 7.0%; CA vs. PLA, P = 0.292; CA vs. PA, P = 0.142; PLA vs. PA, P = 0.031). Surgeons without board certification were assigned to a similar percentage to perform both techniques for any DI (CA 30.3% vs. 37.1%, P = 0.541; PLA 31.8% vs. 40.5%, P= 0.484; PA 40% vs. 35.3%, P = 1.0). We found no significant differences concerning AA (1.5% vs. 1.2%, P = 1.0) and WI (3.1% vs. 1.6%, P = 0.61). LESS-A can be done by surgeons with and without board certification for all DI, with shorter DO and similar complication rates as compared to 3TA.

Several studies have been conducted to investigate the prevalence of preeclampsia and eclampsia in Iran. These studies have yielded different results. This meta-analysis was aimed to estimate the prevalence of preeclampsia and eclampsia in Iran. International and national electronic databases were searched up to August 2014 including PubMed, Science Direct, Scopus, Science Information Database, MagIran, and IranMedex as well as conference databases. All studies, in which the prevalence or cumulative incidence of preeclampsia in Iran was reported, were included in this meta-analysis. Thirty-six separate studies were assessed involving overall 132,737 participants, of which 4360 had preeclampsia and 49 had eclampsia. Overall prevalence of preeclampsia and eclampsia was 0.05 (95% CI: 0.05, 0.06) and 0.23% (95% CI: 0.12%, 0.33%) respectively. The prevalence of preeclampsia, increased from 0.04 (95% CI: 0.03, 0.05) during 1996 to 2005 to 0.07 (95% CI: 0.04, 0.09) during 2010 to 2013, while the prevalence of eclampsia decreased from 0.30% (95% CI: 0.15%, 0.45%) to 0.01% (95% CI: 0.01%, 0.01%), during the same period. The preeclampsia prevalence had an increasing growth and the eclampsia prevalence had declining growth in recent years. In addition, despite many studies aimed the prevalence of preeclampsia and eclampsia in Iran, there is a significant variation between the results. So, it is difficult to give an exact estimation of the preeclampsia and eclampsia prevalence in Iran.

The branch anatomy of the aortic arch varies widely between individuals. These are likely due to alterations in the development of aortic arch arteries during the embryonic period. The purpose of this study is to determine the frequency of the aortic arch branch variations in the local population and provide useful data to intervention radiologists, neck and thoracic surgeons. In this study, branching pattern of the aortic arch in 226 patients was retrospectively evaluated by MR angiography. MRA performed on a high field 3 Tesla MRI scanner using 3D flash sequence. The normal aortic arch branching pattern was observed in 192 patients (84.9%). Also, three variations of the aortic arch branching pattern were observed. The aortic arch in 12.4% of the patients had two arterial branches. In 0.9% of cases, the left vertebral artery originated directly from the aortic arch. In 1.8% of cases, the right subclavian artery originated as the fourth aortic arch branch. Although the number of cases with aortic arch branches variation in our study is similar to other studies, the Bovine aortic arch variation is more common than other variations of aortic arch branches.

Plasma cell leukemia (PCL) is a very rare and progressive hematologic malignancy with unpleasant prognosis, which present with monoclonal proliferation of plasma cells in peripheral blood. Here we report a 52-year-old female case of PCL which diagnosed by morphology and immunohistochemistery (IHC) study. IHC revealed CD20+/CD38+/CD138+/CD56-/kappa-/lambda+. We diagnose PCL on peripheral blood. IHC can be helpful for prognostic determination.

Ectopic liver is a rare developmental abnormality. It is often asymptomatic and could be determined during the surgery. AIthough it could be detected in different areas of the body either below or above of the diaphragm, ectopic liver is usually found on the wall of the gallbladder. The importance of the ectopic liver came from the elevated risk of development of hepatocellulary carcinoma from ectopic tissue. Ectopic liver tissue could also mimic malign masses in radiographic studies. Ultrasound-guided percutaneous biopsie scould be helpful for preoperative diagnosis. Recently, widespread usage of laparoscopic techniques caused an increase on the description of ectopic liver tissues located on the gallbladder. Due to the potential risk of developing malignancy. the resection of the mass should be the preferred approach for an incidentally or intraoperatively diagnosed ectopic liver tissue.