فهرست مطالب

Archives of Iranian Medicine - Volume:22 Issue:6, 2019
  • Volume:22 Issue:6, 2019
  • تاریخ انتشار: 1398/04/25
  • تعداد عناوین: 12
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  • Motahareh Kheradmand, Mahmood Moosazadeh*, Majid Saeedi, Hossein Poustchi, Sareh Eghtesad, Ravanbakhsh Esmaeili, Reza Alizadeh Navaei, Akbar Hedayatizadeh Omran, Roja Nikaeein, Alireza Rafiei, Ghasem Janbabaee, Zahra Kashi, Mehrnoush Sohrab, Mahboobeh Shirzad AhooDashti, Mahdi Afshari, Bahareh Golpour, Mohsen Aarabi, Iradj Maleki, Hafez Tirgar Fakheri, Ali Ghaemian, Mehran Zarghami, Alireza Ghaemi Pages 279-285
    Background
    The Tabari cohort study (TCS), part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN), is a large longitudinal prospective cohort designed to better understand the risk factors associated with major non-communicable diseases (NCDs) across two urban and mountainous regions in north of Iran.
    Methods
    The enrollment phase of TCS started in June 2015 and ended in November 2017. During this phase, individuals aged 35–70 years from urban and mountainous regions of Sari township (Mazandaran province) were invited to the cohort center by health volunteers (urban regions) and Behvarz (mountainous areas) using census information. Data was collected based on the PERSIAN cohort study protocols. Hypertension was defind as systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg or history of diagnosis with hypertension or taking antihypertensive medications among participants free from cardiovascular diseases. Diabetes was defined as fasting blood sugar ≥126 mg/dL or a history of diagnosis or taking glucoselowering medications among all participants.
    Results
    A total of 10,255 participants were enrolled in TCS, 59.5% of whom were female. Among the total population, 7,012 participants were urban residents (68.4%). The prevalence of daily smoking in the total population was 9.1%. Body mass index in 75.9% of participants was ≥25 kg/m2. The prevalence of hypertension, diabetes, and thyroid disorders were 22.2%, 17.2%, and 10.5%, respectively.
    Conclusion
    The Tabari cohort is different from other cohorts in terms of levels of risk factors associated with NCDs. This study has certain important strengths including its population-based design and large sample size that provides a valid platform for conducting future investigations and trials. A biobank that has been designed to store blood, nail, hair and urine samples for future research is another strength of this study. Researchers who are interested in using the information can refer to the following web page: http://persiancohort.com.
    Keywords: Cancer, Cardiovascular, Cohort, Mazandaran, PERSIAN, Risk factor, Tabari cohort
  • Mahdi Sharif Alhoseini, Mohammadreza Zafarghandi, Vafa Rahimi, Movaghar, Zahra Heidari, Khatereh Naghdi, Somayeh Bahrami, Sahar Koohi Habibi, Marjan Laal, Ali Moradi, Zahra Ghodsi, Moein Khormali, Meghdad Abdolhoseinzadeh, Melika Khaleghi Nekou, Payman Salamati* Pages 286-292
    Background
    The main objective was to describe the results of the pilot phase of the national trauma registry of Iran (NTRI) at a referral university trauma center in Tehran.
    Methods
    The study was performed at Sina Hospital in Tehran, Iran from August 1 to September 30, 2016. Patients who had the NTRI criteria were included. 109 data variables were analyzed including demographics, medical care information, injury characteristics, and outcomes.
    Results
    Over 2 months, 171 patients, predominantly males (87.1%) with an average age of 37.2 (±19.5) years were registered. The most common mechanism of injury was road traffic crash (RTC) (53.2%), followed by fall (21.1%) and penetrating injuries (18.7%). RTC represented a remarkable proportion of the injuries with higher injury severity score (ISS) (P = 0.046). The mean hospital length of stay (LOS) was 9.8 (±12.2) days. There were significant relationships between Glasgow Coma Scale (GCS) (P = 0.03), drug abuse (P = 0.05), and ISS (P = 0.008) as independent variables and LOS. 21.6% of the patients were admitted to ICU, with a larger proportion of fall injuries (44.4%) (P = 0.002). Eight patients (4.7%) died during hospitalization, of which 7 cases were male. There was significant association between increasing age and ISS with death outcome.
    Conclusion
    After successful implementation of NTRI at a major trauma center in Tehran, RTC was identified as the main cause of admission. Most patients were young men. The mean time interval between injury occurrence and hospital admission was too long. These findings could be used to improve quality of trauma care and formulate targeted preventive strategies.
    Keywords: Data systems, Medical records, Registries, Wounds, injuries
  • Nazila Rezaei, Farhad Pishgar, Moein Yoosefi, Ali Sheidaei, Sahar Saeedi Moghaddam, Anita Mansouri, Leila Tahernia, Shohreh Naderimagham, Mitra Modirian, Forough Pazhuheian, Negar Rezaei, Alireza Namazi Shabestari, Farzad Kompani*, Farshad Farzadfar Pages 293-300
    Background
    Cancer, a common disease in adulthood, is a rare albeit slowly increasing condition among children. Currently, limited data are available on the incidence, prevalence, and mortality of these diseases in many regions, including developing countries. Herein, we are reporting national and sub-national estimates on deaths due to childhood cancers between 2000 and 2015 in Iran.
    Methods
    Cancer mortality rates were estimated using the national death registration system’s data after addressing its incompleteness and misclassification, using demographic (complete birth history and summary birth history) and statistical analysis (spatiotemporal, Gaussian process regression, and generalized linear mixed models). We included data from cemeteries of two cities (Tehran and Isfahan) that were not included in the death registration system. We used census data and household expenditure and income surveys for data on population and other covariates used in the modeling.
    Results
    The overall age-standardized death rate (ASDR) of childhood cancers have decreased by 69.52% (80.67–49.71) in Iran (equal to an annual percent change of -3.63 [-4.53– -2.24]), declining from 12.24 (95% UI: 10.52–14.49) in 2000 to 3.73 (2.8–5.29) deaths per 100000 in 2015. This decrement was equal to an annual percent change of 4.35% over these years. Leukemia, brain, and nervous system malignancies accounted for about 66% of all cancer-related mortalities among children and adolescents in 2015, which had a 10% increase compared to 2000. Moreover, trends at the sub-national level showed that the highest and lowest ASDR of childhood cancers ranged from 2.12 to 4.99 across provinces of Iran in 2015.
    Conclusion
    Although the overall mortalities have decreased, there is still inequality in the distribution of the recorded deaths. This inequality should be addressed with the improvement of the quality of care and better access to pediatric hospitals and oncologists in these areas.
    Keywords: Cancer, Child, Epidemiology, Iran, Mortality
  • Mahdi Nalini, Maryam Sharafkhah, Hossein Poustchi, Sadaf G. Sepanlou, Akram Pourshams, Amir Reza Radmard, Masoud Khoshnia, Abdolsamad Gharavi, Sanford M. Dawsey, Christian C. Abnet, Paolo Boffetta, Paul Brennan, Masoud Sotoudeh, Arash Nikmanesh, Shahin Merat, Arash Etemadi, Ramin Shakeri, Reza Malekzadeh*, Farin Kamangar* Pages 301-309
    Background
    It is unclear which anthropometric obesity indicator best predicts adverse health outcomes. This study aimed to investigate the association of body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and hip-adjusted WC with all-cause and cardiovascular mortality.
    Methods
    50045 people aged 40–75 (58% women, median BMI: 26.3 kg /m2 ) participated in the population-based Golestan Cohort Study. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) for the association of obesity indicators with mortality. We also examined the association of these indicators with intermediate outcomes, including hypertension, blood glucose, dyslipidemia, carotid atherosclerosis, nonalcoholic fatty liver, and visceral abdominal fat.
    Results
    After a median follow-up of 10.9 years (success rate: 99.1%), 6651 deaths (2778 cardiovascular) occurred. Comparing 5th to the 1st quintile, HRs (95% CIs) for all-cause and cardiovascular mortality were 1.12 (1.02–1.22) and 1.59 (1.39–1.83) for BMI, 1.16 (1.07–1.27) and 1.66 (1.44–1.90) for WC, 1.28 (1.17–1.40) and 1.88 (1.63–2.18) for WHtR, 1.44 (1.32–1.58) and 2.04 (1.76–2.36) for WHR, and 1.84 (1.62–2.09) and 2.72 (2.23–3.32) for hip-adjusted WC, respectively. Hip-adjusted WC had the strongest associations with the intermediate outcomes.
    Conclusion
    Indicators of visceral adiposity (e.g., hip-adjusted WC) were much stronger predictors of overall and cardiovascular mortality than were indicators of general adiposity (e.g., BMI). The full-strength effect of visceral adiposity becomes apparent only when both WC, as a risk factor, and hip circumference, as a protective factor, are individually and simultaneously taken into consideration.
    Keywords: Body mass index, Cardiovascular, Hip circumference, Mortality, Obesity, Waist circumference
  • Ladan Mehran, Shahin Yarahmadi, Davood Khalili, Mehdi Hedayati, Atieh Amouzegar, Pouria Mousapour, Nasrin Ajang, Fereydoun Azizi* Pages 310-317
    Background
    The newborn screening (NBS) program for congenital hypothyroidism (CH) was launched on a national scale in Iran since 2005; we evaluated the program in 15 provinces, from 2011 to 2014.
    Methods
    Fifteen provinces, including 17 districts, were included in the study. Aggregated data of screening, diagnosis, and management of all neonates born in each district in 2011 were retrospectively gathered and collectively analyzed.
    Results
    Program coverage ranged from 77 to 100% in different districts. The positive predictive value was low and widely ranged from 1.3 to 15.5. Transient congenital hypothyroidism (TCH) distribution values were over 5 mU/L in more than 3% of the population and were reported in 9 out of 17 districts. Repeated screening test due to inappropriate sampling varied from 0.9% in Lorestan to 36% in Zabol. Recall rate varied from 0.16 in Ardebil to 1.58 in Zanjan. CH incidence was high, with the highest value being observed in Zanjan (1:241 newborns). Screening age at 3–5 days from birth were highly observed in Gonabad (95.2%) and Zanjan (94.5%), with the lowest values observed in Giroft, Zabol, Kerman and Tehran. CH treatment was initiated before 40 days of age in 90.6% of cases. Survival time for TSH normalization event varied among the districts from 25 to 163 days. After withholding treatment at 3 years of age, TCH was identified in 30%–60% of hypothyroid cases.
    Conclusion
    Main indicators of the screening program have reached the optimal goals defined by the Ministry of Health and Medical Education. However, high false positive rate and non-optimal neonatal TSH distribution values necessitate readdressing these challenging issues.
    Keywords: Congenital hypothyroidism, Evaluation, Newborn, Screening
  • Samaneh Saberi, Razieh Karamzadeh, Parisa Moghadam, Morteza Kadivari, Bahareh Eghbal Behbahani, Zahra Heydari, Hossein Baharvand, Farzaneh Aminpour*, Massoud Vosough* Pages 318-327
    Background
    Accomplishments in stem cell science and tissue engineering have resulted in a remarkable revolution in the context of future medicine. However, a general insight over the progress of stem cell research in Iran is still lacking. A better understanding of current needs in this field is required to design a better national roadmap.
    Methods
    In this study, we defined the geographical regions based on the significance of their contribution to stem cell research; then, using the Scopus database, we retrieved reports from Iran and other countries concerning stem cell science and regenerative medicine published from 1994 until the end of 2016.
    Results
    A significant number of citations belong to North America (6554029 citations equal to 49% of the total citations) and Europe (4425465 citations equal to 33% of the total citations) and the rest of citations were related to Asia (2423352 citations equal to 18% of the total citations). East Asian (2168472 citations equal to 76% of the total citations related to Asia) documents were cited more than those from the Middle East (ME) (494141 citations equal to 17% of the total citations related to Asia) and North and Central Asia (196382 citations equal to 7% of the total citations related to Asia). Iran as a country in the ME attracted 17% of the total citations related to the Asian countries winning the second position in this regard. The overview of total number of citations showed a sharp increase and upward trend in citation numbers for all the Iranian institutes from 2007 that resulted in the expansion of stem cell science in all major cities of Iran such as Shiraz (8%), Mashhad (5%), Isfahan (5%) and Ahvaz (5%). H-index of Tehran University of Medical Science, which has the highest total citations and document numbers, is the highest among all Iranian research institutes. Citation per paper of Royan Institute (RI) is the highest among the top 10 Iranian institutes, by 13 citations per paper.
    Conclusion
    Stem cell research in Iran is rapidly developing. Since 2007, the number of published documents in major research institutes increased; thus, there is necessity for analysis of the status of publications in this field and choosing a better direction based on needs. Furthermore, it is necessary to expand and organize international collaborations to enrich our research and benefit from different team experiences.
    Keywords: Bibliometrics, Iran, Research Assessment, Regenerative Medicine, Stem Cells, Scientometrics
  • Behzad Zamani, Elnaz Daneshzad, Leila Azadbakht* Pages 328-335
    Background
    Gastrointestinal (GI) cancers are common types of cancers. Among different factors that affect the etiology of GI cancers, diet has an important contribution. Dietary antioxidants decrease oxidative stress which plays a pivotal role in carcinogenesis. Several studies assessed the relation between dietary total antioxidant capacity (TAC) and risk of GI cancers. Dietary TAC was measured by three indices including FRAP (ferric ion reducing antioxidant power), TRAP (total radical-trapping antioxidant parameter), and TEAC (trolox equivalent antioxidant capacity). We performed a systematic review and meta-analysis of published studies to determine the association between dietary TAC and GI cancers risk.
    Methods
    Eligible studies were selected from PubMed, ISI Web of Science and Scopus databases from inception until May 2018. Case-control and cohort studies that reported GI cancer risk estimates for dietary TAC were included. We ignored the distinction between case-control and cohort studies. We applied random-effects to estimate pooled relative risks. Subgroup analysis was done based on study design.
    Results
    Among the seven observational studies that were included, four were cohort studies and three were case-control studies. Dietary FRAP, TRAP, and TEAC reduced GI cancer risk: FRAP; 0.71; 95% CI: 0.58–0.85, TRAP; 0.65; 95% CI: 0.57–0.75, TEAC; 0.70; 95% CI: 0.59–0.83, respectively.
    Conclusion
    This study indicated that dietary TAC significantly decreased the risk of GI cancers. Nevertheless, further prospective studies are required to clarify the association between dietary TAC and risk of GI cancers.
    Keywords: Cancer risk, Dietary total antioxidant capacity, FRAP, Gastrointestinal cancers, TEAC, TRAP
  • Hanfei Lin, Kefei Wu, Weidai Zhang, Guili Lin, Chudan Cai* Pages 336-339
    Evans syndrome is a rare syndrome associated with the simultaneous or sequential development of autoimmune hemolytic anemia (AIHA) and idiopathic thrombocytopenic purpura (ITP). Furthermore, acute kidney injury (AKI) is a syndrome characterized by the rapid loss of kidney excretory function and is most often secondary to extrarenal events. However, AKI has rarely been recorded in Evans syndrome without systemic autoimmune disease and malignant tumors of the blood and lymphatic system. Herein, we report the case of a patient who exhibited Evans syndrome presenting with AKI. A 73-year-old woman presented with diarrhea, anuria, low platelet count, and developed a progressive increase of blood urea nitrogen and serum creatinine, as well as anemia with a positive direct Coombs test. We excluded hemolytic uremic syndrome, ITP, and leukemia. Treatment with antibiotics, rehydration therapy, and hemodialysis resulted in partial remission; thus, we diagnosed the patient with Evans syndrome presenting with AKI. The patient was successfully treated by the addition of steroid treatment. When AKI presents with hemolysis and thrombocytopenia, physicians should consider Evans syndrome, which can be appropriately treated when detected early.
    Keywords: Acute kidney injury, Evans syndrome
  • Chew Kah Teik*, Nurul Iftida Basri, Abdul Kadir Abdul Karim, Muhammad Azrai Abu, Mohd Faizal Ahmad, Nur Azurah Abdul Ghani, Erica Yee Hing, Rozman Zakaria, Jegan al Thanabalan, Azizi Abu Bakar, Nor Azlin Mohamed Ismail Pages 340-343
    Cerebral arteriovenous malformation (AVM) is a rare entity with an estimated prevalence of 0.01-0.05% in the general population. We reviewed hospital obstetric records during 2010-2017 and reported a case series of six patients with cerebral AVM in pregnancy, of which five patients had successful pregnancy, and one maternal mortality
    Keywords: Cerebral arteriovenous malformation, Management, Outcome, Pregnancy
  • Reza Jafari, Ali Reza Ranjbar, Reza Farid Hosseini* Pages 344-352
    The oldest literature that mentioned the immunity was related to the plague of Athens in 430 BC. The germ theory had more influence on the description of the discrimination between self and non-self which is the core concept of immunology. Allergic diseases were known from 2,000 years ago while Rhazes wrote the first medical monograph about seasonal allergic rhinitis. In Iran, Dr. Mohammad Kermanshahi introduced the basic concepts of serology in 1900. The first Department of Serology was established at Tehran University, Faculty of Medicine in 1951 by Prof. Dr. Hassan Mirdamadi. After that, immunology entered into the cellular and molecular period. Prof. Mohammad Ali Maleki established the first Iranian Society of Allergy and then Prof. Abolhassan Farhoodi found the first Department of Clinical Immunology and Allergy at Tehran University. In this paper, we review the role of famous Iranian scientists and physicians in the progress of modern immunology and allergy from a historical perspective.
    Keywords: Allergy, History, Immunology, Iran