Archives of Iranian Medicine
Volume:25 Issue: 3, Mar 2022

While hepatitis B virus (HBV) is the most prevalent cause of adult liver transplants in Iran, the mortality rates and leading causes of death in HBV patients are not well-understood. This study aimed to investigate all-cause and cause-specific mortality among HBsAg positive individuals in a large Iranian cohort.

The Golestan Cohort Study includes 50045 individuals aged 40–75 residing in Iran’s Golestan province, enrolled during 2004–2008. HBsAg test was performed at baseline. For the present study, individuals with hepatitis C coinfection were excluded. All-cause mortality was considered as the primary outcome. The association between HBsAg and different mortality causes was evaluated using Cox proportional hazard models. P value<0.05 was considered significant.

The current study included 49667 participants. After 11.33 (median) follow-up years, there were 7,686 total deaths, with 635 deaths in the HBsAg positive group. In the multivariate Cox proportional hazard model, HBsAg positive individuals had higher all-cause (adjusted hazard ratio [aHR]=1.15, 95% CI: 1.06–1.24) and liver-related mortality risk (aHR=7.13; 5.19–9.79). Mortality from colorectal and pancreatic cancers was higher among male HBsAg positive participants (aHRs=2.41 and 2.22, respectively). Nevertheless, cardiovascular diseases (CVDs) and extrahepatic malignancies were the leading causes of death among both HBsAg positive and negative individuals, and liver-related deaths contributed to an overall 10% of deaths in HBsAg positive patients.

HBV is associated with significant mortality risk from different causes in Iranian adults. However, solely focusing on liver outcomes in Iranian HBV patients might result in overlooking non-liver events, especially CVD and extrahepatic cancers.

Acute pancreatitis is one of the most common complications of endoscopic retrograde cholangiopancreatography (ERCP). Studies suggest that intrapancreatic calcium has an important role in activating pancreatic enzymes; in addition, elevated intraductal pressure is required for development of pancreatitis. Magnesium sulfate (MS), as a calcium antagonist and a muscle relaxant of the Oddi sphincter, is suggested to reduce the incidence and severity of post-ERCP-pancreatitis (PEP) in this article.

We included 270 patients who referred for ERCP between March 2017 and March 2018. They were enrolled into MS (2 g) and placebo (normal saline) groups, administered 1 hour before and 6 hours after the procedure. The ERCPs were done by fellows of gastroenterology under supervision of expert physicians. The incidence and severity of PEP were followed.

PEP was seen in 12 (8.9%) patients in the MS group and 17 (12.6%) in the placebo group (P value=0.33). The incidence of PEP in high risk patients group (P value=0.017).

Although the usage of MS was not able to prevent PEP in all patients enrolled in this study, but it could significantly reduce the incidence of PEP in high risk patients of intervention group in comparison with placebo group. The median length of hospital stay was also significantly lower in new drug group in contrast to placebo.

People with simple renal cysts (SRCs) are more likely to develop renal injury and dysfunction, but the mechanisms remain controversial, as the process of SRC formation and its characteristics are not yet well-known. This research focuses on the characteristics of SRCs and discusses how SRCs cause renal injury.

In 2014, a total of 401 participants without any prior kidney disease were selected for the research. Their average age was 49.7 years. SRC morphology and changes were monitored over a 5-year follow-up period. Renal volume and blood perfusion were measured by ultrasound imaging. Logistic regression analysis was used to assess the relationship between renal cyst and renal function.

During the 5-year follow-up, elderly participants with multiple cysts (odds ratio [OR] 1.89; 95% CI 1.67 to 5.99) and a maximum cyst diameter of 1.5 cm or greater (OR 1.93; 95% CI 1.15 to 5.34) were found to be positively correlated with renal injury. A decrease in intrarenal perfusion was observed at the early stages of follow-up, but the reduction in renal volume was a slow and gradual process.

Elderly people with multiple cysts, a maximum cyst diameter of the cysts≥1.5 cm, and multiple cysts are more likely to suffer renal injury. Ultrasound examination has an important status in monitoring the changes in renal volume and peak systolic velocity (PSV) of the renal interlobar artery.

There are limited data on the Mycobacterium tuberculosis (MTB) drug resistance in regions located at the proximity of the Caspian Sea. We aimed to assess the drug resistance patterns of the MTB isolates to anti-tuberculosis drugs in patients from four northern provinces of Iran between April 2013 and March 2019.

Drug susceptibility testing (DST) was performed by culturing MTB isolates on the Lowenstein-Jensen medium using the proportion method.

Out of 963 MTB isolates, 927 (96.3%) were recovered from Iranian cases and 36 (3.7%) were from Afghan immigrants. Based on DST, 59 (6.1%) showed any drug resistance pattern, while 18 patients (1.9%) were multidrug-resistant (MDR) or rifampicin-resistant (RR). Resistance to streptomycin (STR), isoniazid (INZ), rifampicin (RIN), and ethambutol (ETL) was reported in 33 (3.4%), 28 (2.9%), 18 (1.9%), and 12 isolates (1.2%), respectively.

The rate of MDR/RR in four northern provinces of Iran was in line with previous reports from the World Health Organization. Due to proximity to the former Soviet Union, which had a high rate of MDR/RR isolates, the establishment of cross-border tuberculosis (TB) control strategies is recommended to reduce the possibility of MDR-TB transmission. Moreover, DST for all TB cases is recommended as an effective diagnostic tool for optimal monitoring and control of drug resistance in these areas. Future studies with a molecular epidemiology approach will be needed to evaluate the transmission dynamics of MTB in these regions.

Laboratory analysis errors in procedure or interpretation may be seen during the process of completing physician test orders. They may also result in rejection of the requests due to some applicability reasons. Hence, this study was carried out to determine the rate and reasons for such rejections in clinical settings.

This cross-sectional comparative study was performed on 104008 laboratory tests in a one-year period in terms of the percentage and type of errors that occurred in Shahid Bahonar Hospital in Kerman, Iran, in 2018. The types of studied errors included hemolysis, sample clotting, insufficient sample size, and mistakes in labels or absence of labels on the sample.

In this study, 104008 laboratory tests were performed, with 2299 (2.21%) sample rejections, 456 (32.31%) complete blood count (CBC) sample clotting; 417 (29.38 %) hemolysis; and 150 (17.47 %) inadequate sample volume as the majority of errors. There was no statistically significant relationship between pre-analysis errors and clinical aspects (P=0.124).

According to the results, it may be concluded that considering the high prevalence of laboratory errors in comparison with the majority of other studies, continuous training courses and determination of the causes of these errors are crucial to attaining better function and basic knowledge.

Medullary thyroid cancer (MTC) is a rare type of neuroendocrine tumor. This study aimed to investigate the gene and protein expression of RAP1GAP and DNA methylation patterns of its CpG74a , CpG74b , and CpG24 in an Iranian population with MTC.

In this case-control study, we selected 55 individuals who underwent thyroidectomy in Erfan hospital, Tehran, between 2018 and 2020. Samples were divided into normal thyroid tissues (control; n=20), benign nodule (n=20), and MTC (n=15). DNA methylation patterns were investigated using MSP (methylation-specific PCR). The protein level and mRNA expression of RAP1GAP were also evaluated using western blotting and real-time PCR, respectively.

The hyper-methylation rates of CpG24 and CpG74a in the MTC samples were considerably higher than the controls (83% versus 15% and 74% versus 17%, respectively; P<0.001). The methylation/unmethylation ratio of CpG74a , and CpG24 was considerably higher than the controls (P<0.001). The methylation/unmethylation ratio of CpG24 in the benign nodules was also considerably greater than the controls (P<0.001). The mRNA expression and the protein level of RAP1GAP in the MTC group were considerably lower than the controls (P=0.005 and P=0.035, respectively). In the MTC group, aberrant methylation of CpG74a and CpG24 was significantly correlated with decreasing expression of the Rap1Gap gene (R2 : 0.23; P=0.032 and R2 : 0.56; P=0.001, respectively).

Hyper-methylation in CpG24 and CpG74a and decreasing expression of RAP1GAP can be considered as diagnostic biomarkers for MTC.

Rhinosinusitis involves inflammation within the paranasal sinuses and the nasal mucosa. It is a very common chronic health condition. This paper performs a validation process on the Persian translation of the rhinosinusitis quality-of-life questionnaire (RhinoQOL), for use in clinical assessment of chronic rhinosinusitis (CRS) patients. The Lund-Mackay score is also used widely in assessing CRS, and this study aims to describe its relationship to RhinoQOL.

The Persian RhinoQOL adaptation was carried out on 110 CRS patients. A follow-up questionnaire was completed two weeks later. Psychometric properties were determined by statistical analysis (reliability, reproducibility, validity, responsiveness). A total of 45 patients were included for radiologic score calculation. The Spearman’s test was used for assessing the correlation between the RhinoQOL scores and Lund-Mackay score.

Internal reliability was excellent for the impact scale (Cronbach’s alpha=0.92). Cronbach’s alpha was 0.63 and 0.55 for frequency and irritation scales, which reflects lower internal consistency values. Temporal stability or Test-retest reliability was excellent across all three scales. ICC was 0.96, 0.97, and 0.99 for RhinoQOL frequency, irritation, and impact scales. No significant correlation was observed between the Lund-Mackay score and RhinoQOL scores in terms of frequency, irritation and impact scales.

The Persian version of RhinoQOL appears to be as reliable, valid, and sensitive to change as the English version.

International economic sanctions (IES) influence a country’s economic development and the overall welfare of a nation’s population.

An electronic search of PubMed, Embase and Web of Science was conducted until July 31, 2019. Additionally, a list of references to related articles was reviewed. Key search terms were “Economics”, “Health”, “Sanction”, and their equivalents with no language or time restriction.

Totally, 8624 records were identified of which 2869 duplicates were deleted. Finally, 24 papers met the inclusion criteria and were selected for drafting. The number of papers included for evaluating each factor included healthcare (n=16) and pharmaceutical industry (n=10). Nine and eight studies examined the effect of sanctions imposed on Iran and Iraq, respectively. France, Haiti, Serbia, Cuba, Syria, and other areas such as Africa were also evaluated. Sanctions lead to a decrease in immunization rates and government health care expenditures. Sanctions increase infant and under-five mortality rate, road traffic injuries and fatalities, severe malnutrition, infective diseases, neurologic and visual disorders, as well as shortage of medical or dental instruments and a variety of medicines. Sanctions have adverse impacts on female labor and are associated with disabling hospitals, dispersing medical workers, and facilities for radiation therapy.

The health status of sanctioned nations in terms of healthcare, and pharmaceutical industry was adversely affected in targeted countries.

Adenoid cystic carcinoma (ADCC) is a malignant tumor of salivary gland origin. ADCC of sinonasal tract is rare. We present a rare and unresectable case of sinonasal ADCC with intracranial extension in an 83-year-old man with the chief complaint of nasal congestion. Invasion to the maxillary sinus, nasopharynx, anterior cranial fossa, sella turcica and extension to cavernous sinus, dura mater and infratemporal fossa were evident on MRI and CT scan. The patient was treated only by palliative radiotherapy, but unfortunately, he died 3 months after the initial diagnosis.

Abdulkarim Vessal, a distinguished professor of the Shiraz School of Medicine, was the founder of the “Archives of Iranian Medicine Journal” and a permanent member of the “Iranian Academy of Medical Sciences”, who finally, after five decades of efforts to promote radiology and medical journalism in Iran, passed away on February 18, 2022 in Shiraz. His demise is a great loss for the Iranian medical community, especially in Shiraz. In the present paper, his life and career are briefly reviewed.