Archives of Iranian Medicine
Volume:23 Issue: 7, Jul 2020

Inherited peripheral neuropathies (IPNs) are a group of neuropathies affecting peripheral motor and sensory neurons. Charcot-Marie-Tooth (CMT) disease is the most common disease in this group. With recent advances in next-generation sequencing (NGS) technologies, more than 100 genes have been implicated for different types of CMT and other clinically and genetically inherited neuropathies. There are also a number of genes where neuropathy is a major feature of the disease such as spinocerebellar ataxia (SCA) and hereditary spastic paraplegia (HSP). We aimed to determine the genetic causes underlying IPNs in Iranian families.

We performed whole exome sequencing (WES) for 58 PMP22 deletion-/duplication-negative unrelated Iranian patients with a spectrum of phenotypes and with a preliminary diagnosis of hereditary neuropathies.

Twenty-seven (46.6%) of the cases were genetically diagnosed with pathogenic or likely pathogenic variants. In this study, we identified genetically strong variants within genes not previously linked to any established disease phenotype in five (8.6%) patients.

Our results highlight the advantage of using WES for genetic diagnosis in highly heterogeneous diseases such as IPNs. Moreover, functional analysis is required for novel and uncertain variants.

The present study aims to assess the incidence and mortality rates of gynecological cancers and their changes from 1990 to 2016 at national and subnational levels in Iran.

Annual estimates of incidence and mortality for gynecological cancers from 1990 to 2016 at national and subnational levels were generated as part of a larger project entitled National and Subnational Burden of Diseases, Injuries, and Risk Factors (NASBOD). After the precise processing of data extracted from the Iran Cancer Registry, annual age-standardized incidence and mortality rates were calculated for each cancer, province, year and age group during the period of the study.

In 2016, gynecological cancers constituted 8.0% of new cancer cases among women of all ages compared to 3.7% of new cases of cancer among women in 1990. The incidence rate of gynecological cancers has increased from 2.5 (0.9-5.6) per 100000 women in 1990 to 12.3 (9.3–15.7) per 100000 women in 2016, and the most common gynecological cancer has changed from cervical cancer in 1990 to corpus uteri cancer in 2016. Age-standardized incidence rates of ovarian, corpus uteri and vulvovaginal cancers increased from 1.3 (0.5–2.4), 1.7 (0.6–3.0), and 0.3 (0.0–0.7) in 1990 to 4.4 (3.6–5.2), 9.9 (6.8–13.4), and 0.6 (0.2–1.0) in 2016, respectively, showing a 3.3, 5.8 and 1.7-fold increase during this period. Age-standardized incidence rate of cervical cancer was 2.4 (1.7–3.3) cases per 100000 women in 2016 and did not differ significantly from the beginning of the study. An overall reduction was seen in national mortality to incidence ratios (MIR) from 2000 to 2015.

The incidence rates of all gynecological cancers in different provinces have shown a converging trend that could indicate that attempts toward health equality have been effective. The declining trend of MIR could be interpreted as advancements in detection of cancer in its early stages and also improvements in treatments, in turn reflecting improvements in access to and quality of care.

To describe the protocol for developing a national inherited retinal disease (IRD) registry in Iran and present its initial report.

This community-based participatory research was approved by the Ministry of Health and Medical Education of Iran in 2016. To provide the minimum data set (MDS), several focus group meetings were held. The final MDS was handed over to an engineering team to develop a web-based software. In the pilot phase, the software was set up in two referral centers in Iran. Final IRD diagnosis was made based on clinical manifestations and genetic findings. Ultimately, patient registration was done based on all clinical and non-clinical manifestations.

Initially, a total of 151 data elements were approved with Delphi technique. The registry software went live at www. IRDReg.org based on DHIS2 open source license agreement since February 2016. So far, a total of 1001 patients have been registered with a mean age of 32.41±15.60 years (range, 3 months to 74 years). The majority of the registered patients had retinitis pigmentosa (42%, 95% CI: 38.9% to 45%). Genetic testing was done for approximately 20% of the registered individuals.

Our study shows successful web-based software design and data collection as a proof of concept for the first IRD registry in Iran. Multicenter integration of the IRD registry in medical centers throughout the country is well underway as planned. These data will assist researchers to rapidly access information about the distribution and genetic patterns of this disease.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new coronavirus, was diagnosed in China in December 2019. Around the globe, a total of 71429 were infected up to February 17, 2020, with 98.9% of cases in China. On March 11, 2020, the World Health Organization (WHO) characterized the COVID-19 as ‘pandemic’. Rapid positive worldwide incidence was the motivation behind this study to investigate the incidence and mortality globally.

We used the data published by the WHO until March 9, 2020. Non-parametric tests and change point analysis were used for inferences.

Change point analysis for Iran and China and the world excluding China for the first 20 days revealed around 78, 195 and 2 further new cases per day, respectively. Italy had a big jump in incidence on the 36th day. Similarly, a sharp rise of positive cases was reported for the world on the 35th day. China successfully controlled the ascending reports of incidence on the 23rd day. Mortality in China and the world were almost similar for the first 20 days. There was an ascending incidence trend with two change points in Italy (30th and 36th days) and one change point in Iran on the 17th day. Mortality in the world jumped remarkably after day 42 with an estimation of almost more than 25 deaths per day.

The incidence of COVID-19 varied by regions; however, after March 11, it became ‘pandemic’. It was observed that after about 6 days with an emergence of sharp increase in incidences, there would be a mutation in mortality rate. On the other hand, the importance of ‘on-time’ quarantine programs in controlling this virus was confirmed.

The initiation age and prevalence of cigarette smoking are two important parameters in any smoking-related policymaking domain.

Dataset was extracted from STEPs survey, a population-based study conducted in Iran in 2016. A total of 27612 participants were included in the current study. We used a spatial parametric survival mixture rate cure model with doubly censoring to simultaneously assess the initiation age and prevalence of smoking.

The entire study population, men and women had the estimated median initiation age of 23.3 (95% CI: 22.2–24.5), 21.9 (95% CI: 21.3–22.5), and 25.5 (95% CI: 22.8–28.7) years, and the prevalence of 10.11% (95% CI: 9.3%–11.0%), 22.3% (95% CI: 21.0%–23.6%), 0.78% (95% CI: 0.62%–0.97%), respectively. The hazard of smoking initiation in men was 66% which was higher than in women (hazard ratio [HR] = 1.66, 95% CI: 1.15-2.48). The odds of smoking in men was 36.5 times greater than that of women (odds ratio [OR] = 36.5, 95% CI: 29.66-45.52). Odds of smoking decreased by 32% in the entire study population and 14% with one level increase in their education (OR = 0.68, 95% CI: 0.65-0.72) and socioeconomic status (OR = 0.86, 95% CI: 0.82-0.94), respectively. The geographical distribution of smoking initiation age varied from 21.5 to 26.37 years for the entire study population, 20.2 to 24.8 years for men, and 23.53 to 28.91 years for women. The geographical distribution of smoking prevalence varied from 5.46% to 14.98% for the entire study population, 12.82% to 30.98% for men, and 0.4% to 1.2% for women.

The geographical distribution of smoking initiation age and prevalence showed that in different parts of the country, the initiation age and rate of smoking are different which should be considered in any preventative policy making.

The aim of this paper is to present a synthesis of solutions for post-graduate medical education (PGME) and the health-care system in addressing challenges in relation to women’s health.

A critical review was conducted within three themes: women’s health status, women’s preferences for female physicians, and women in surgery. The study was conducted in two phases that consisted of an analysis of the trends of Iranian women’s health and women’s participation in PGME since 1979 followed by a thematic analysis to assess the current challenges and their implications on medical education.

Our analysis revealed important trends and challenges. Since 1979, life expectancy has increased by 29% in Iranian women, while female adult mortality rate has decreased by 78%, and maternal mortality rate has decreased by 80%. The number of female medical specialists has increased by 933% , while the number of female subspecialists has increased by 1700%. According to our review, ten major challenges regarding women’s health were identified: 1) Increase in chronic disease; 2) Increase in cancer cases; 3) Preference for same-gender physicians in sensitive procedures; 4) Delayed care-seeking due to lack of female surgeons; 5) Lack of gender-concordance in clinical settings; 6) Underestimating female surgeons’ capabilities; 7) Female physicians’ work-family conflicts; 8) Male-dominancy in surgical departments; 9) Women’s under-representation in higher rank positions; and 10) Lack of women in academic leadership.

We identified different solutions to bridge these gaps. Community-based education, Gender- concordant considerations, and empowering women in surgical departments could help medical education policy makers to address the challenges.

Chorioamnionitis (CAM) is one of the major risk factors for neonatal early-onset sepsis (EOS). Different international guidelines have been developed for diagnosis and care of such neonates. This research aimed to evaluate our neonates and compare them with the guidelines.

This prospective cohort study was conducted during five years (March 2012 to March 2017), and comprised of neonates (any gestational age) born to mothers with CAM (any criteria). The neonates’ clinical findings and interventions were collected and analyzed.

In total, out of 28,988 live born neonates, CAM was found in mothers of 169 neonates (1.7%). Among the studied neonates, 30.8% were born ≤34 week of gestation, 39% had birth weight <2500 g, and 58.6% were asymptomatic. Out of 99 asymptomatic neonates, 47 were observed near mothers and 52 admitted to the neonatal intensive care unit (NICU). The frequency of abnormal tests was 23.07% in asymptomatic vs. 35.7% in symptomatic neonates; three neonates developed culture positive EOS (2.75%) and 68.05% of the neonates received antibiotics. The length of stay was 2.59 ± 1.13 (median = 2.00, IQR = 1.00) days in asymptomatic vs. 15.15 ± 13.67 (median = 7.00, IQR = 15.25) days in symptomatic neonates (P<0.001).

The use of guidelines increased the length of stay, lab tests, and antibiotics in asymptomatic and neonates with negative blood culture. In addition to the mother-neonate separation, these guidelines may increase nosocomial infection, antibiotic resistance, and costs; therefore, new guidelines are needed to be developed.

Phyllodes tumor (PT) is a rare tumor of the breast, which may occur during pregnancy or lactation. Several studies have reviewed and discussed PT occurring in pregnancy, gathering up to 14 patients. We performed a thorough systematic review of the literature in an attempt to find all reported cases, and identify their common characteristics.

We searched Google scholar, PubMed, Ovid Medline, Scopus and ClinicalTrials.gov with several relevant combinations of keywords, looking for texts or abstracts without any date or language limitations, but using only English keywords. The existing literature only consisted of case reports and series; therefore any paper including one or several cases of PT presenting during pregnancy or breastfeeding was recognized as eligible. Articles with vague description of the tumor which made the diagnosis uncertain, and those lacking data about the tumor and management data were excluded. We contacted authors for more details in cases with incomplete information.

After excluding those with very deficient data, we included 37 studies, counting 43 cases. The mean age of the patients was 31 years (21-43 years). Some features were different from usual PT: bilaterality (16.2%), large size (14.2 ± 8.6 cm), rapid enlargement (79.5%), and rate of malignancy (60.5%).

Our findings show high rates of bilaterality, large size, rapid growth, and malignant pathology in the reported gestational PTs.

A recent outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected more than 1100000 (April 5, 2020) individuals worldwide and is spreading rapidly. The virus is reported to be derived from bats and the infection was first reported in China. Similar to the severe acute respiratory syndrome and the Middle East respiratory syndrome coronaviruses, it is responsible for respiratory tract infection. Real time polymerase chain reaction and radiography are the two main diagnostic methods. Guidelines from the Center for Disease Control and Prevention and the World Health Organization (WHO) should be followed for diagnostic and precautionary measures. Treatment of the infection is still not available; however, antivirals are under clinical trials.

The novel coronavirus, formerly named as 2019 novel coronavirus (2019-nCov) caused a rapidly spreading epidemic of severe acute respiratory syndrome (SARS) in Wuhan, China and thereafter, progressed globally to form a pandemic of coronavirus disease 2019 (COVID-19) in numerous countries; and now confirmed cases are reported from several provinces of Iran. Now various medical centers, clinicians and researchers around the world share their data and experiences about COVID-19 in order to participate in the global attempt of controlling the pandemic. The current report investigates the clinical presentations and paraclinical findings of the first confirmed cases and mortalities in the initiation of the outbreak of COVID-19 in Iran.