Archives of Iranian Medicine
Volume:12 Issue: 1, Jan 2009

Insights into long-term clinical consequences of sulfur mustard have emerged from some investigations but less is known about the basic and molecular mechanisms of these complications. Sardasht-Iran Cohort Study is a comprehensive historical cohort study on Sardasht chemical victims'' population which was designed to find out the long-term complications of sulfur mustard exposure and the basic mechanisms underlying clinical manifestations. This paper describes the design and methodology of Sardasht-Iran Cohort Study. In Sardasht-Iran Cohort Study, 500 individuals including 372 subjects from Sardasht, as the exposed group, and 128 subjects from Rabat, as the unexposed age-matched control group were evaluated. The exposed group was divided into two groups based on the severity of clinical complications at the time of exposure. Different samples including blood, sputum, saliva, tear, urine, and semen were collected for immunologic, hematologic, biochemical, and other laboratory analysis. Data were gathered from medical records, clinical examinations, laboratory tests, and questionnaires for psychological and lifestyle situations. The important distinctions setting this study apart from the previous ones are discussed. The Sardasht-Iran Cohort Study provides important information on various aspects of long- term consequences of sulfur mustard exposure. This database will provide a better position to suggest guidelines for the diagnosis, treatment, and prevention of delayed complications in the patients exposed to sulfur mustard.

There are no population-based data available for cancer in Tehran, a city that includes almost 10% of the Iranian population. This is the first report of cancer incidence in Tehran from a population-based cancer registry for the period of 1998 – 2001. The cancer registry collects data on all new cases of cancer diagnosed in the resident population of Tehran metropolitan area. Data collection is active and trained abstractors visit close to 120 data sources comprising cancer diagnostic laboratories, secondary- and tertiary- care hospitals, and imaging centers to abstract cancer cases. During the period of 1998 – 2001, a total of 34,318 eligible cases were abstracted of which 24% were identified just by death certificates. The overall age-standardized rates (ASR) (adjusted to the world population structure) were 163.0 per 100,000 males and 141.8 per 100,000 females. The most frequently reported malignancies in males were stomach cancer (ASR 19.8), followed by cancers of the prostate (ASR 15.6), lung (ASR 14.9), bladder (ASR 13.3), non-Hodgkin''s lymphoma (ASR 7.1), and esophagus (ASR 6.8). In females, the most frequently reported malignancies were breast cancer (ASR 31.4), followed by cancers of the stomach (ASR 10.0), lung (ASR 7.0), ovary (ASR 6.8), and esophagus (ASR 5.3). The data reported by the Tehran Cancer Registry provide information on the cancer profile in Tehran metropolitan area. It clearly shows the breast and stomach, prostate, and tobacco-related cancers as major cancer in this population. The observed cancer rates indicate that Helicobacter pylori eradication, tobacco control measures, and early detection of breast cancer are of importance for cancer control in this population.

Continuous ambulatory peritoneal dialysis is not a very common modality to treat Iranian children with end-stage renal disease; however, there is sometimes no choice but to offer this therapy to salvage the patient. Obviously, promotion in each program needs re-evaluation to find the pitfalls. Therefore, a nation-wide survey on pediatric continuous ambulatory peritoneal dialysis was conducted to find the cause of death or termination of dialysis. All children, younger than 14 years old, treated by continuous ambulatory peritoneal dialysis in nine main pediatric nephrology wards in Iran between 1993 and 2006 were included in this historical cohort study. Patient and technique survival rates were determined. Kaplan-Mayer and Cox-regression analysis were used to compare the survival. 2×2 table was used to calculate the risk ratio. A P<0.05 was considered significant. One hundred twenty children with a mean age of 47.6 months were on continuous ambulatory peritoneal dialysis. The most frequent cause of renal failure was hereditary-metabolic-cystic disease. One hundred eighty-two peritoneal dialysis catheters were inserted surgically. The median first catheter exchange was 0.74 year (95%CI: 0.5 – 0.98). The most frequent cause of catheter replacement was catheter outflow failure due to displacement, adhesion, and infection (persistent peritonitis or tunnel infection). The mean patient survival was 1.22 years (95%CI: 0.91 – 1.53). The mortality rate was 55% before 1997, and 60% between 1998 and 2001, which declined to 23% after 2002 (P<0.05). Young age (<24 months) was the only independent factor that predicted mortality (P<0.05). The outcome of children was as follows: recovery of renal function (6.7%), renal transplantation (8.3%), switch to hemodialysis (16.7%), still on continuous ambulatory peritoneal dialysis (23.3%), death (43.3%), and lost to follow-up (1.7%). The mortality is still high among Iranian children on peritoneal dialysis. Young age is the most important factor influencing on survival and mortality.

One of the main methods for evaluation of fetal well-being is analysis of Doppler flow velocity waveform of fetal vessels. Evaluation of Doppler wave of the middle cerebral artery can predict most of the at-risk fetuses in high-risk pregnancies. In this study, we tried to determine the normal ranges and their trends during pregnancy of Doppler flow velocity indices (resistive index, pulsatility index, systolic-to-diastolic ratio, and peak systolic velocity) of middle cerebral artery in 20 – 40 weeks normal pregnancies in Iranians.

In this cross-sectional study, 1037 women with normal pregnancy and gestational age of 20 to 40 weeks were investigated for fetal middle cerebral artery Doppler examination.

Resistive index, pulsatility index, and systolic-to-diastolic ratio values of middle cerebral artery decreased in a parabolic pattern while the peak systolic velocity value increased linearly with progression of the gestational age. These changes were statistically significant (P<0.001 for all four variables) and were more characteristic during late weeks of pregnancy. The mean fetal heart rate was also significantly (P<0.001) reduced in correlation with the gestational age.

Doppler waveform indices of fetal middle cerebral artery are useful means for determining fetal well-being. Herewith, the normal ranges of Doppler waveform indices for an Iranian population are presented.

Experimental studies have shown that in myelomeningocele, the primary malformation is neural tissue damage resulting from exposure of neural tissue to amniotic fluid. In this study, the effects of amniotic fluid on histopathologic changes of exposed spinal cord in fetal sheep were evaluated. In an experimental trial, 10 fetal sheep in two groups containing five subjects (group A) and five shams (group B) were studied. In the sheep at 90 – 100 days of gestation (term: 145 – 150 days) the lumbar skin was incised, paraspinal soft tissues were excised, laminectomy was performed at L2 - L4, and dura matter was opened. In group A, the dura matter was not dorsally closed and thus the spinal cord was left exposed to amniotic fluid, and in group B the skin was immediately closed. The lambs were delivered near term by cesarean section and were assessed clinically and morphologically. In group A, all lambs (n=5) had a complete or incomplete flaccid sensorimotor paraplegia and suffered from urine incontinence. Four lambs in this group were stool incontinent. In group B (n=4), only one lamb had paraparesis (P=0.048) and all lambs were urine and stool continent. In group A, all lambs had hypoplastic longitudinal muscles of the rectum but well- developed circular muscles. The anal sphincter muscles did not develop normally. In group B, all lambs had well-developed longitudinal and circular muscles and anal sphincter muscles developed normally (P=0.048). Histopathologic examination of the spinal cords showed edema, focal calcification, fibrosis, and capillary cell proliferation in group A, but in group B such changes were not seen. The number of ganglion cells was significantly higher in group B compared with group A (P<0.0005). Exposure of spinal cord to amniotic fluid causes structural neural tissue damage that can be prevented by fetal surgery through repairs of myelomeningocele.

Considering the difficulties in diagnosing bipolar disorder in clinical practice and lack of needed screening instruments in Persian language, the present study aimed at assessing sensitivity, specificity, and predictive values for the Persian Bipolar Spectrum Diagnostic Scale. The study was conducted in a university-affiliated hospital in Tehran, Iran, in a sample of 181 consecutive outpatients aged 18 – 65 years. The used instruments were the Structured Clinical Interview for DSM-IV axis I disorders, the Persian Bipolar Spectrum Diagnostic Scale, the Persian Mood Disorder Questionnaire, and the Scale to Assess Unawareness of Mental Disorder. Most patients were males (58%) and had bipolar I disorder (57%). Other bipolar disorders and major depressive disorder were diagnosed as 5.5% and 21%, respectively. Test-retest of the Persian Bipolar Spectrum Diagnostic Scale and Mood Disorder Questionnaire demonstrated a good reliability for both. The sensitivity, specificity, and positive and negative predictive values of the Persian Bipolar Spectrum Diagnostic Scale at the score of 14, were 0.52, 0.79, 0.81, and 0.49, respectively. The sensitivity and specificity of the parallel application of the Persian Bipolar Spectrum Diagnostic Scale and Mood Disorder Questionnaire were 0.76 and 0.67, respectively. The Persian Bipolar Spectrum Diagnostic Scale and Mood Disorder Questionnaire are useful in screening patients with bipolar disorder in clinical psychiatric settings. Parallel use of both tests seems more effective than either alone.

To assess the level of knowledge, attitude, and practice among Iranian dental healthcare professionals towards standard isolation precautions in Shiraz, Iran. This study was a cross-sectional survey which was conducted on 152 Iranian dental professionals (faculty and students) from School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran. A self-administered questionnaire containing three parts (knowledge, attitude, and practice) was distributed to the participants. After validation of the survey, data were collected and analyzed. The survey was completed by 152 (51.5%) of 295 potential respondents. The mean±SD scores of knowledge, attitude, and practice towards standard isolation precautions were 6.71±0.99, 34.99±4.47, and 4.97±2.17 from the maximum scores of 9, 45, and 9, respectively. In addition, a positive linear correlation was found between the two items of the survey including knowledge-attitude (r= 0.394, P< 0.001), and attitude and practice (r= 0.317, P<0.001). Practice of standard isolation precautions is poor among dental professionals in Shiraz University of Medical Sciences. This study showed that knowledge of infection control measures and a positive attitude towards them alone does not have an impact on adherence to recommendations.

Tendon entrapment of the first dorsal compartment of the wrist, the de Quervain disease, is a common cause of wrist and hand pain and disability. A group of 50 consecutive patients operated for the treatment of de Quervain disease from 2003 through 2006 were prospectively studied to determine the variation in the pattern of the first extensor compartment. Eighty-six percent of the patients were females, and 14% were males. In 80% of the cases the nondominant and in 20% the dominant hand was involved. These interesting findings may rule out the occupation’s relation to de Quervain disease. Our study revealed that the compartment is completely separated into two canals in 86% of the patients which was significantly higher than that reported in similar studies. The existence of two separated compartments for abductor pollicis longus and extensor pollicis brevis tendons should be considered as a common finding during operation to prevent incomplete treatment and recurrence of the symptoms.

This study was conducted to determine the treatment outcome of incompletely removed, histopathologically documented ocular surface squamous neoplasia with mitomycin-C. Through an interventional case series, 17 eyes of 17 patients presented with incompletely removed ocular surface squamous neoplasia were treated according to a protocol using two to three alternate seven-day courses of 0.04% mitomycin-C. Clinical recurrence was re-treated with the same protocol. All patients had weekly follow-up visits to the end of the treatment course, then biweekly visits for three months, and monthly visits, thereafter. The mean±SD follow-up period was 30.76±4.4 (range: 24.5 – 41) months. Five patients (29.4%) experienced recurrence after the initial treatment; four of them responded to retreatment and were disease-free till the end of follow-up. Survival analysis with Kaplan-Meier method was performed. Taking into account four recurrences, the 41-month nonrecurrence rate was 70.6%. However, including four of five patients with recurrence who responded to retreatment, the final outcome in survival analysis was 94.1% nonrecurrence for 41 months of follow-up.All patients reported mild to moderate redness and irritation which were controlled with lubricants and mild corticosteroid eye drops. No serious ocular or systemic side effects were observed. Point zero four percent (0.04%) mitomycin-C drop used as two to three alternate seven-day courses seems to be a safe and effective treatment for ocular surface squamous neoplasia.

The present study examined the influence of group positive parenting program on parental stress of mothers of children with attention-deficient/hyperactivity disorder. Mothers of 13 children aged four to ten years, who met attention-deficient/hyperactivity disorder diagnosis by assessment of a child psychiatrist and clinical psychologist were selected from two child and adolescent psychiatric clinics of Tehran. To control the drug effects, researchers chose children who took methylphenidate (Ritalin) since six months before. The group programs consisted of a six-weekly session of two hours duration, plus two telephone educational sessions, each one lasting 15 minutes. Group was run by an experienced clinician who followed a specific training manual to ensure a standard format. These sessions continued with eight participants, because five of 13 mothers did not attend the classes. The results indicated that group positive parenting program caused mothers to experience lower stress. A two-month follow-up showed the stable efficiency of the program. This study revealed that the competency feeling and couples’ harmony—as intervening variables—about nurturing the child were improved.

From March 1991 through 31st December 2007, 2042 patients underwent stem cell transplantation at the Hematology-Oncology and Stem Cell Transplantation Research Center, affiliated to Tehran University of Medical Sciences. These transplantations included 1405 allogeneic stem cell transplantation, 624 autologous stem cell transplantation, and 13 syngeneic stem cell transplantation. Stem cell transplantation was performed for various diseases including acute myelogenous leukemia, acute lymphoblastic leukemia, chronic myelogenous leukemia, chronic lymphoblastic leukemia, thalassemia major, sickle cell thalassemia, sickle cell disease, multiple myeloma, myelodysplasia, mucopolysaccharidosis, paroxysmal nocturnal hemoglobinuria, non-Hodgkin’s lymphoma, Hodgkin’s disease, severe aplastic anemia, plasma cell leukemia, Niemann-Pick disease, Fanconi anemia, severe combine immunodeficiency, congenital neutropenia, leukocyte adhesion deficiencies, Chediak-Higashi syndrome, osteopetrosis, histiocytosis X, Hurler syndrome, amyloidosis, systemic sclerosis, breast cancer, Ewing''s sarcoma, testicular cancer, germ cell tumors, neuroblastoma, medulloblastoma, renal cell carcinoma, nasopharyngeal carcinoma, ovarian cancer, Wilms’ tumor, rhabdomyosarcoma, pancreatoblastoma, and multiple sclerosis. We had 105 cellular therapies for postmyocardial infarction, multiple sclerosis, cirrhosis, head of femur necrosis, and renal cell carcinoma. About 30 patients were retransplanted in this center. About 74.9% of the patients (1530 of 2042) remained alive between one to 168 months after stem cell transplantation. Nearly 25.1% (512 of 2042) of our patients died after stem cell transplantation. The causes of deaths were relapse, infections, hemorrhagic cystitis, graft versus host disease, and others.

Several pain assessment tools have been proposed for use in different settings, but neither have been validated for all patients, especially Iranians.We conducted this study to compare the accuracy of two most commonly used tools for evaluation of pain intensity in a group of postoperative Iranian patients.All postoperative patients admitted to the surgical wards of Masih Daneshvari and Rasoul Akram Hospitals, Tehran, Iran were studied. During a two-month period, patients were evaluated for pain intensity within 24 hours of operation. Visual analogue scale and faces rating scale were used for this purpose.Eighty- two patients were enrolled into the study. Forty-eight patients underwent obstetrics and 34 had general surgeries. Using Spearman analysis, we found a linear correlation between the results of the two methods (P=0.952). Using multivariate analysis, we found that none of the variables such as age, gender, and education level had significant effects on correlation between visual analogue scale and faces rating scale.Visual analogue scale and faces rating scale are two pain assessment tools that can be used interchangeably for evaluation of acute postoperative pain.

Autoimmune liver diseases are different entities that sometimes have overlapping features. They share many of the general characteristics of autoimmune diseases, with systemic involvements. Here, we report a 30-year-old woman with ophthalmic symptoms of conjunctivitis and dacryocystitis who was treated completely. After a few months, the patient presented with autoimmune cholangio­pathy. Sequelae of autoimmunity have been considered in different organs in this case.

Scimitar syndrome or congenital pulmonary venolobar syndrome is a rare anomaly most commonly consisting of partial pulmonary venous drainage into the hepatic portion of the inferior vena cava, right lung hypoplasia, dextroposition of the heart, and anomalous systemic arterial supply from aorta or one of its branches to the right lung. We report a four-year-old girl with recurrent pneumonia and failure to thrive, who was diagnosed as having scimitar syndrome.

The history of Shiraz University School of Medicine (the former Pahlavi University School of Medicine) is important if we are to understand the develop­ment of medical education in Iran during the 20th century. This medical school took a unique path to its development including full-time faculty members, use of English as its institutional language, and empha­sis on self learning. However, the most important of all is that it applied scientific method and modern knowledge to the problems of Iran and that it emphasized the importance of relevance of medical education to the problems of the region.This article summarizes the foundation and process of development of this school, emphasizing its unique features. This is not the history of individuals who were critical to its development. Nor a history of struc­tures and buildings. Rather, it is the story of its intellectual development, and its process of change as the University became relevant.