Journal of Iranian Medical Council
Volume:3 Issue: 1, Winter 2020

Trump announced its withdrawal from the Joint Comprehensive Plan of Action on May 8, 2018 and consequent sanctions on the Iranian banking system has meant that provisions for 3% of the drugs that are used in Iran which the Iranian drug companies cannot produce and/or 30% of the raw material for pharmaceuticals which Iran cannot produce has become harder and harder for the Ministry of Health and Medical Education to procure. In another words, the sanctions prevented many essential drugs from getting to Iran and made financial transactions so difficult that medicine prices often rose in the process. This complex web of sanctions has led banks and companies to pull back even from humanitarian trade with Iran (1,2).

Since December 2019, an emerging virus called SARS-CoV-2 has spread in Wuhan, China, and has now become a global “pandemic” with the development of a disease called Covid-19. High emission capability and significant mortality of this disease indicate the need for immediate and effective attention to this issue. So far, many efforts have been made to introduce an effective treatment for Covid-19. Due to the contagiousness and high prevalence of the disease, chemoprophylaxis is a topic of discussion that is frequently asked by people and medical staff. The most suitable of the proposed drugs for this purpose are Chloroquine and Hydroxychloroquine which, besides anti-malarial and anti-inflammatory effects, have also antiviral effects. However, for introducing these drugs as prophylaxis, more evidence is needed.

In this study, the existing articles and studies on the use of Chloroquine and Hydroxychloroquine as an effective drug in the prevention of Covid-19 have been studied. References used in this review were identified through a search of PubMed and Google Scholar with keywords of “Hydroxychloroquine”, “Chloroquine”, “COVID-19”, “COVID 19”, “2019-nCoV”, “2019-CoV”, “coronavirus”, “ SARS-nCoV-2”, “antiviral”, and “prophylaxis”. Articles obtained from this search and relevant references were reviewed and included.

Available studies on the pharmacological effects of Chloroquine and Hydroxychloroquine on SARS-CoV-2 have been performed in the laboratory (In vitro). Till now, 5 clinical trials have been conducted in this field and their preliminary results will be published in the next few months. There are also different prophylactic doses suggested in existing studies.

Due to the lack of sufficient clinical evidence and the uncertainty about the dose required to create a prophylactic effect against the disease and due to possible complications, the use of these drugs for prophylaxis is not recommended until the first results of clinical studies are published and then approved by WHO, CDC and FDA. Sufficient attention should be paid to personal protective equipment.

People living in temporary residential centers such as camps and shelters for a short period of time (from one day up to 6 months) are more likely to be infected with HIV, Hepatitis B and C and Tuberculosis because of their high risk behaviours. Therefore, screening and identification of people with these diseases can help cure and prevent the spread of the said diseases in the society. These centers have made intermittent efforts to diagnose and treat their clients. However, to improve the services rendered to these people in the areas of HIV/AIDS, hepatitis C and tuberculosis, we have tried to establish an exhaustive unified protocol for these centers in order to be used as a guideline for diagnosis, treatment and care and follow–up upon the patients´ discharge. In order to implement the project with the aim of diagnosing and connecting to treatment, the centers first reported on the measures taken so far and interviews were conducted with the authorities, staff and clients of said centers. After reviewing the existing protocols at these centers, examining the strengths and weaknesses of the centers and the facilities and processes they use to diagnose, treat, and in particular to follow-up after the patient is discharged – to make sure the patients continue treatment and adhere to medications; training sessions were held at the centers whereby each of the administrative and health staff and clients were individually provided with the necessary training in prevention, diagnosis and treatment and they were assigned some tasks in line with the project objectives. Based on the training, we developed a model that identifies the role of everyone (client, administrative staff, health care personnel and physicians) in the process of the project and all of its different phases and stages which can be used as an unified and practical protocol at all of the target centers. In this model, the stages of diagnosis, screening, testing, accessing treatment clinics, receiving medication, how to use the medicines while staying in the centers, as well as follow-up and adherence to treatment up to one year after discharge were considered. Due to the problems in the operating system of these centers, the protocol intended to not only make the diagnosis and treatment process more accurate but also pay close attention to adherence to the treatment and connection to the treatment centers and guidelines after the client is discharged.

Several studies have been conducted on the relationship between sleep disorders and gestational diabetes. In this study, the relationship between the quality and quantity of sleep and the incidence of gestational diabetes in pregnant women was assessed. In this case-control study, the quality and quantity of sleep in pregnant women attended to the Perinatology clinic at Yas Hospital, Tehran, Iran between June 2016 to September 2017 and its relationship with gestational diabetes mellitus was assessed. In this research, 3000 pregnant women at 24 to 28 weeks of pregnancy were enrolled. Gestational diabetes screening test was initially performed on Glucose Challenge Test (GCT) with administration of 50 gr of glucose. For abnormal cases, Oral Glucose Tolerance Test (OGTT) with administration of 100 gr of glucose after an overnight fasting (8-10 hours) was requested. According to the Gestational Diabetes Mellitus (GDM) diagnosis criteria based on the American Diabetes Association (ADA), women were divided into two groups of case and control (290 diabetic cases and 2710 non-diabetic cases). The Pittsburgh Sleep Quality Index (PSQI) and the participants’ demographic information were collected. Ultimately, 290 of 3,000 women in the study, based on the ADA criteria were diabetic and non-diabetic patients were 2710 women. Sleep quality in the diabetic mothers was significantly worse than non-diabetic mothers and the duration of sleep of them was higher than non-diabetic mothers (p<0.05). Quality and quantity of sleep can be associated with the incidence of gestational diabetes and diabetic mothers have worse sleep quality and longer sleep times than non-diabetic mothers.

A low Resting Metabolic Rate (RMR) as a risk factor for weight gain can be affected by many factors. However, the role of Dietary Inflammatory Index (DII) in RMR is still unknown. This study was designed to examine the association between resting metabolic rate per kilogram of fat-free mass and DII. This cross-sectional study was conducted among 304 Iranian overweight and obese women aged 18-50 years. RMR was measured by indirect calorimetry. Bioelectrical Impedance Analysis (BIA) was used to determine Fat Free Mass (FFM) and other body composition parameters. A validated 147-item FFQ was used to compute dietary inflammatory index. Participants that consumed more pro-inflammatory foods, compared to those with lower intake had significantly a lower odds ratio for increased RMR/FFM (OR: 0.40; 95% CI: 0.16-0.91; p=0.01). Moreover, after adjusting for potential confounders, a significant inverse association between DII and RMR/FFM was observed in overweight women (OR: 0.31; 95% CI: 0.09-0.98; p=0.04). In this study, an inverse association between DII score and RMR/FFM in overweight women was observed. Further studies, in particular prospective cohorts with long-term follow-up, are required to confirm these findings.

Acute leukemia is the most prevalent hematologic malignancy in children and infections are the most prevalent complication in this group. There are few studies on viral respiratory infections in children with leukemia. This article aimed to study the frequency of influenza, Respiratory Syncytial Virus (RSV) and Human Metapneumovirus (HMPV) respiratory infections in children with leukemia.

This is a cross-sectional study on 110 children with leukemia referred to Amir Hospital (Shiraz) from Aug 23th 2015 to Feb 20th 2016. Fifty-five children had respiratory symptoms (Case group) and fifty-five children had no respiratory symptoms (Control group). RT-PCR was done on respiratory secretions for influenza, RSV and HMPV in both groups. Data was analyzed by SPSS for Windows version 18. A p value

RT-PCR for influenza, RSV or HMPV was positive in 14 children in case group and 3 children in control group (p=0.004). The 2 groups were significantly different for having family members with respiratory symptoms (p=0.001), having a history of antiviral drugs usage (p=0.008), duration of the last admission (p<0.05), fever (p=0.001), duration of fever (p<0.05), and neutropenia (p=0.002).

Symptomatic viral respiratory infections are prevalent in children with leukemia. Attention must be paid to respiratory viruses in leukemic children, and if available, specimens should be tested for the presence of influenza viruses, RSV and metapneumovirus.

Obesity is introduced as one of the chronic diseases in most of the countries. In fact, 75 to 80% of obese youngsters will remain obese in adulthood. This study as a novel one was conducted to evaluate the possible association between the age at onset of obesity and body composition as well as Resting Metabolic Rate (RMR) in overweight and obese adult women. A total of 295 overweight and obese women aged 18-50 years were enrolled in this cross-sectional study. Over the past year, dietary intake and nutritional status were evaluated using a semi-quantitative Food Frequency Questionnaire (FFQ) including a list of 147 food items. An impedance fat analyzer (InBody 720, Korea) was used to obtain the body composition and an indirect calorimeter was applied to assess the RMR. T-test was used to compare the means of two groups at onset of obesity for quantitative variables, while multiple linear regression was used to assess the relationship between the age at onset of obesity with body composition and RMR. The results of our study showed that subjects in the upper age group at onset of obesity had lower RMR (p=0.02) and age (p≤0.001) than those in the lower age group. The outcomes showed that an earlier onset of obesity was significantly associated with higher body weight (Beta: -0.11, CI: -0.30 to -0.00, p=0.005) and fat mass (Beta: -0.13, CI: -0.23 to -0.01, p=0.02). After adjustment for confounders including age, physical activities, and total energy intake, those differences still remained significant. Furthermore, RMR per body weight became significant too (Beta: 0.16, CI: 0.00 to 0.11, p=0.03). The results of the present study demonstrated a direct association between the age at onset of obesity and RMR per body weight, but it was inversely related to body weight and fat mass. Prospective studies are needed to confirm these findings.

The purpose of this study was to assess the personality and driving behavior in normal and Attention Deficit Hyperactivity Disorder (ADHD) patients with traumatic injury admitted to Rajaee Hospital. This study was conducted in 2013 at Shiraz Trauma Center. All patients with physical trauma who referred to Shahid Rajaee Hospital, Shiraz, Iran were included; 60 male subjects with or without ADHD symptoms were selected. Demographic factors were assessed by a self-report questionnaire and driving behavior and personality traits were assessed by Manchester driving behavior questionnaire (MDBQ) and Neo Five Factor Inventory (NEO_FFI), respectively. Among 60 patients evaluated in this study, 29 males were diagnosed with ADHD and 31 were classified as non-ADHD group. There was a significant difference between ADHD and non-ADHD groups in the frequency of accidents (p<0.001), injury history (p<0.003), driving behavior (p<0.01), and personality (p<0.05). ADHDs had a higher mean score of neuroticism, extraversion, openness and agreeableness; in addition, ADHDs had more injuries and accidents. It can be concluded that one of the main factors that cause riskier driving behaviors is EF and in conjunction with other comorbidities such as ADHD or personality disorders, it can increase risky driving behavior which can lead to more accidents and injuries.

Inflammatory Fibroid Polyp (IFP) is a rare and uncommon benign lesion that originates in the submucosa of the gastrointestinal tract. Its clinical symptoms are heterogenous and depend on the location and size of the tumor. Inflammatory fibroid polyps are one of the rare benign conditions leading to intestinal intussusception in adults.

A 76-year-old woman presented to the emergency department with acute abdominal pain, vomiting, nausea and failure in defecation and gas passing. Physical examination revealed abdominal distension. Abdominal X-ray showed dilated small bowel segments with air-fluid levels. Operative finding was an ileo-ileal intussusception due to a mass lesion at 40 cm proximal to the cecum. Intussusception was spontaneously reduced during exploration and a wedge resection was performed for the affected bowel segment. Histopathologic examination showed the mass to be an inflammatory fibroid polyp. About 4 days after the operation, the patient was discharged from the hospital and there was no particular problem during the 6 month follow up.

Although IFP is an extremely rare cause of small intestine obstruction, it should be taken into consideration in patients with obstruction.