Archives of Iranian Medicine
Volume:10 Issue: 4, oct 2007

Cotard syndrome is a rare condition, which its main symptom is nihilistic delusion. Self-mutilation of the nose is also a rare condition, which has not been seen in schizophrenic patients with Cotard syndrome. A single case is presented here. A 32-year-old woman who was diagnosed as having schizophrenia and believed that she was dead, cut the tip of her nose. She had no guilt feeling and described her act as a cosmetic surgery. We try to explain how various symptoms that seem to be very far from each other could exist side by side. Misinterpretation of her face is suggested to be the starting point in her complex symptoms.

Surgical closure of ventricular septal defect is safe, however, the inherent risks associated with cardiopulmonary bypass and the potential early and late postsurgical complications including complete heart block, arrhythmias, postpericardiotomy syndrome, and rare deaths have led physicians to prefer transcatheter occlusion technique for closure of such defects. The use of Amplatzer muscular ventricular septal defect occluder is safe and associated with a higher success rate than other previously used devices. For the first time in Iran, we report an 18-year-old patient with ventricular septal defect who was successfully treated using the Amplatzer ventricular septal defect occluder.

Iran has a longstanding history and a rich heritage of medicine. Two reputable Persian medical scholars of the Middle Ages are Razi (Rhazes) and Ibn-Sina (Avicenna). Their most important otorhinolaryngologic contributions based on the relevant data from two major medical books i.e., al-Hawi (Liber Continens) and Qanun fi-Tebb (Canon of Medicine) are discussed

Background/ To assess the inequity in seeking needed outpatient services in Iran and to investigate its influential factors. The data were taken from a nation-wide Iranian health survey conducted in 2003. This study is based on individuals aged 15 years and over who had mentioned their need to seek outpatient care within two weeks prior to the day of the interview. The outcome was seeking needed outpatient care. The independent variables included respondents'' age, gender, marital status, education, occupation, index of household economic status, health insurance status and residential place (urban vs. rural). Sixty-nine point five percent of those in need sought outpatient care. The rich (OR: 2.38, 95% CI: 1.64 – 3.43) and the health insured (OR: 1.62, 95% CI: 1.25 – 2.08), the pensioners and the retired (OR: 2.26, 95% CI: 1.22 – 4.20), the housewives (OR: 1.77, 95% CI: 1.07 – 2.95) were more likely to seek outpatient care than other occupations. On the other hand, people living in remote rural areas (OR: 0.40, 95% CI: 0.28 – 0.57) were less likely to seek their needed outpatient care than those living in main rural areas and urban areas. As in different parts of the world, differences in seeking needed healthcare still exist across different groups in Iran. Indeed, seeking outpatient care in Iran is related not only to health system functions—like health insurance and health facilities—but also on factors beyond the scope of health authorities such as economic status and occupation. This study can be instrumental for the recent five-year Economic, Social and Cultural Development Plan of Iran which identified the reduction of inequalities in social determinants of health

Background/ To determine the equality in safe delivery indices, i.e., appropriate place of delivery, type of delivery and skilled attendant for delivery, and their determinants in Iran. This study was performed using the data of Iran demographic and health survey, performed in 2000. Our sample was nationally representative and included 17,991 Iranian married women aged 10 – 49 years who had delivered during two years before the survey. The equality status was assessed by concentration index. The relationship between different factors and safe delivery was investigated by logistic regression. These factors included age, occupation, resident place (urban vs. rural), mother’s educational level and household economic status (weighted asset index). Concentration index (95% CI) for appropriate place of delivery, normal vaginal delivery and skilled attendant for delivery, were 0.111 (0.107 to 0.115), -0.100 (-0.105 to -0.095) and 0.095 (0.091 to 0.099), respectively. In other words, the opportunity of delivery in appropriate place and by skilled attendant were more common in those with higher economic levels; while normal vaginal delivery was less common. Also, mother''s age and educational level had significant correlation with safe delivery indices; in all cases mother''s education was the most important factor. In spite of the improvement in delivery care in Iran during the past decades, there are significant differences between the current situations of safe delivery in people with different socioeconomic states.

There is an extreme need for planning to prevent suicide in developing countries. It is necessary to detect the risk factors of this problem and plan to control them. The aim of this study was to determine a predictive model for suicide attempt based on its risk factors in order to give information for planning therapeutic, preventive, and educational interventions in Karaj City. The setting was Karaj City, Tehran Province, Iran and the study design was cross-sectional. In this study, data were collected by using the World Health Organization (WHO) questionnaire of SUPRE-MISS study. The questionnaire included questions about demographic characteristics, personal and family history of suicide behaviors, use of psychotropic drugs, physical and mental disorders, and community stress. All parts of the questionnaire were filled out by interview. A total of 2300 individuals participated in this study having considered the 1.2% prevalence of suicide attempt in the pilot study, and with type one error rate of 5%, the sample size was calculated as 2300. About 65% of the participants were females. Most of the participants had high-school education (48%) and 57.2% of them were married. Housewives included most of the occupation categories (46%). The mean age of the suicide attempters and nonattempters was 26 (±9) and 32 (±13) years, respectively. This difference was statistically significant. Younger age, female sex, history of mental disorders, lifelong use of tobacco and alcohol, and unemployment were the independent predictors of suicide attempt. Prevention of suicide is possible by understanding its risk factors and planning to control them.

The standard treatment for decompensated liver cirrhosis is liver transplantation. However, it has several limitations. Recent animal studies suggest that bone marrow stem cell transplantation can lead to regression of liver fibrosis. The objective of this study was to determine the safety and feasibility of autologous bone marrow-mesenchymal stem cell transplantation in patients with decompensated liver cirrhosis. In this phase 1 trial, four patients with decompensated liver cirrhosis were included. Their bone marrow was aspirated, mesenchymal stem cells were cultured, and a mean 31.73×106 mesenchymal stem cells were infused through a peripheral vein. Primary outcomes were evaluating the safety and feasibility of the work. Secondary outcomes were evaluating changes in the model for end-stage liver disease score, and the quality of life of the patients. There were no side-effects in the patients during follow-up. The model for end-stage liver disease scores of patients 1, and 4 improved by four and three points, respectively by the end of follow-up. Furthermore, the quality of life of all four patients improved by the end of follow-up. Using SF-36 questionnaire, the mean physical component scale increased from 31.44 to 65.19, and the mean mental component scale increased from 36.32 to 65.55. Mesenchymal stem cell transplantation seems to be feasible and safe in the treatment of decompen­sa­ted liver cirrhosis.

Stem cell transplantation after myocardial infarction has been claimed to restore cardiac function. Mesenchymal stem cells attract a lot of attention because of the feasibility of in vivo and ex vivo differentiation to cardiomyocytes and endothelial cells as well as their trophic effect on tissue repair. In this study, we investigated the efficacy of autologous bone marrow derived mesenchymal stem cells in improving heart function in patients with old myocardial infarction. Eight patients with old myocardial infarction and proper inclusion criteria were injected with mesenchymal stem cells at the time of coronary artery bypass grafting or percutaneous coronary intervention (test group) and compared with eight matched patients who received the same treatment without mesenchymal stem cell injection (control group). Evaluation of heart function was done by echocardiography plus single-photon emission computed tomography before and six months after the procedure. Serial clinical examination was performed every month through New York Heart Association class. The mean New York Heart Association class and single-photon emission computed tomography scan results decreased significantly in the test group (P=0.000 and 0.002, respectively) and in the control group (P=0.049 and 0.007, respectively) after the procedure at six months follow-up. Left ventricular ejection fraction increased significantly in the test group (P= 0.005) but not in the control group. In comparison between the test and control groups the results of New York Heart Association class assessment and single-photon emission computed tomography demonstrated significant improvement in the test group (P=0.005 and 0.013, respectively). There were no significant differences between the baseline variables in the two groups. Transplantation of ex vivo expanded bone marrow derived mesenchymal stem cell in patients with old myocardial infarction is a safe and feasible procedure. These cells improve the cardiac function without serious adverse effects.

It has been found that one of the methods to repair peripheral nervous system or even central nervous system injury is to use Schwann cells as nerve regeneration promoters. Therefore, it seems necessary to look for a way to obtain activated Schwann cells, with a sufficient amount of numbers and purity, in a short time for clinical applications. However, the previous methods using mitogens are not much clinically acceptable, and other methods that do not require mitogens, fail to isolate adult Schwann cells effectively or require a long period of time. In this study, Schwann cells were isolated from predegenerated sciatic nerves of adult rat (one to three nerves per primary culture) and subcultivated two times in a week with the 10% fetal bovine serum supplementation. Thereafter, Dulbecco''s Modified Eagle’s Medium media supplemented with 10%, 5%, 2.5%, 1.25%, and 0.625% fetal bovine serum were employed to determine their influence on the density and purity of Schwann cells after a 10-day period of cultivation. The concentrations of fetal bovine serum less than 10% immediately stimulated some morphological changes to happen in Schwann cells but not fibroblasts. Finally, Schwann cells acquired their normal shape on day 6 when fibroblasts just began to alter and die. Our results demonstrated that total cell density was highly significant (P < 0.05) in the medium supplemented with 10% fetal bovine serum (950 cells/mm²) while purity was significant (P<0.05) in the medium supplemented with 2.5% fetal bovine serum (97%) in comparison with other concentrations of fetal bovine serum.

Little is known about the epidemiology of prostate cancer in Iranian men. We carried out an active prostate cancer surveillance program in five provinces of Iran. Data used in this study were obtained from population-based cancer registries between 1996 and 2000. The age-standardized incidence rate of prostate carcinoma in the five provinces was 5.1 per 100,000 person-years. No significant difference was seen in the age-standardized incidence rate of prostate cancer within the provinces studied. The mean±SD age of patients with prostate cancer was 67±13.5 years. The incidence of prostate cancer in Iran is very low as compared to the Western countries. This can partly be explained by lack of nationwide screening program, younger age structure and quality of cancer registration system in Iran.

The pandemic of HIV/AIDS in sub-Saharan Africa and the rise of epidemics in Asia to the previously unforeseen level are likely to have global social, economic, and political impacts. In this emergency, it is vital to reappraise the weight of powerful religious and cultural factors in spreading the disease. The role of Islam in shaping values, norms, and public policies in North African states is to be appreciated for the lowest HIV prevalence in their populations. Yet, the place of religion in prevention of the disease diffusion is not fully understood nor worldwide acknowledged by the primary decision makers. Another topic, which has received little attention to date, despite the abundance of literature concerning the unfortunate Africa’s anti-AIDS campaign, is an issue of colonial past. To better comprehend the share of both traits in diverse spread of HIV in sub-Saharan Africa, we studied the correlation between Muslim and Christian proportions in the state’s population and HIV rate. By this method, Muslim percentage came out as a potential predictor of HIV prevalence in a given state. In another approach, most subcontinental countries were clustered by colocalization and similarity in their leading religion, colonial past, and HIV seroprevalence starting from barely noticeable (0.6 – 1.2%, for Mauritania, Senegal, Somalia, and Niger) and low levels (1.9 – 4.8%, for Mali, Eritrea, Djibouti, Guinea, Guinea-Bissau, Burkina-Faso, and Chad) for Muslim populated past possessions of France and Italy, in the northern part of the subcontinent. Former territories of France, Belgium, Portugal, and the UK formed two other groups of the countries nearing the equator with Catholic prevailing (Democratic Republic of Congo, Republic of Congo, Rwanda, Gabon, and Burundi) or mixed populations comprising Christian, Muslim, and indigenous believers (Benin, Ghana, Uganda, Togo, Angola, Nigeria, Liberia, Kenya, Cameroon, Côte d''Ivoire, and Sierra-Leone), which covered the HIV prevalence range from 1.9% to 7%. Albeit being traced by origin to the central part of the continent, HIV has reached the highest rates in the South, particularly Malawi (14.2%), Zambia (16.5%), South Africa (21.5%), Zimbabwe (24.6%), Lesotho (28.9%), Botswana (37.3%), and Swaziland (38.8%)—all former British colonies with dominating Christian population. In the group ranking list, a distinct North to South oriented incline in HIV rates related to prevailing religion and previous colonial history of the country was found, endorsing the preventive role of the Islam against rising HIV and the increased vulnerability to menace in states with particular colonial record.

Endoscopic third ventriculostomy has become the preferred treatment for obstructive hydrocephalus. The purpose of this paper is to present our experience with ventriculostomy at our center. Twenty-four patients underwent ventriculostomy for the treatment of obstructive hydrocephalus between May 2000 and May 2006. The follow-up period lasted between one and 51 (median: four) months. The mean age of the patients was 31 (range: 0.5 – 67) years. It was determined that the obstructive hydrocephalus was caused by space-occupying lesions in nine patients (eight tumors and one with calcified arteriovenous malformation), aqueductal stenosis in 14 patients, and shunt infection and entrapped fourth ventricle in one patient. Kaplan-Meier survival analysis showed that the proportion of functioning ventriculostomies became stable at rates of 80% to 90% after the third postoperative month. There was no statistically significant difference in the aqueductal stenosis and tumor subgroups (P=0.716). A high rate of functioning ventriculostomies was found in both subgroups: 12 of 14 in the aqueductal stenosis subgroup and eight of nine in the tumor subgroup.In cases of intraventricular tumors, in addition to ventriculostomy, biopsy was performed that successfully helped the patient management. In the present study, the procedure failed in three patients (13%). Ventriculostomy failures occurred within three months after the operation. The cases of treatment failure were one with aqueductal stenosis, one with Chiari I, and one with pineocytoma. There was no permanent morbidity after ventriculostomy in our patients. The results indicated that ventriculostomy is an effective treatment in cases of obstructive hydrocephalus that is caused by aqueductal stenosis and space-occupying lesions. This procedure is worthy for controlling hydrocephalus without shunt and its complications. Early clinical picture after the operation plays an important role in predicting patient''s outcome after endoscopic third ventriculostomy.

Anal canal dilatation and sphincterotomy have been recommended besides hemorrhoidectomy to overcome the anal pressures in the management of hemorrhoids. The aim of this study to compare internal sphincterotomy and hemorrhoidectomy with hemorrhoidectomy alone with respect to manometric and clinical measures. One hundred twenty patients with hemorrhoids were randomly assigned to receive either hemorrhoidectomy with sphincterotomy or hemorrhoidectomy alone. Anal canal pressures including mean squeeze pressure, maximal resting anal canal pressure, and mean resting anal canal pressure, were recorded by manometry before the operation. The patients were evaluated one week and two weeks after the operation clinically and three months later by manometry. The patients were matched with respect to age, gender, and chief complaints. The mean±SD age of the patients in hemorrhoidectomy with sphincterotomy group (A) was 43.8±14 and in hemorrhoidectomy alone group (B) was 43.94±15 years. The male to female ratio was 1.1:1. One week after the operation, there was no statistically significant differences in the frequency of postoperative complications like pain and urinary incontinence between the two groups except for fecal incontinence which was more frequent in group A. After two weeks, the same results with an acceptable improvement in fecal incontinence in group A were observed. Three months after the operation, manometry showed considerable reduction in the mean resting anal canal pressure and maximal resting anal canal pressure in group A; the mean squeeze pressure did not have any changes in either group. We recommend sphincterotomy plus hemorrhoidectomy for patients with high anal canal pressure documented by manometry prior to the operation.

Spinal muscular atrophy is an autosomal recessive disorder characterized by degeneration of anterior horn cells in the spinal cord leading to progressive muscular weakness and atrophy. The spinal muscular atrophy candidate interval genes including survival motor neuron, the responsible gene in spinal muscular atrophy phenotype expression, neuronal apoptosis inhibitory protein, and P44, potential modifying genes, are located on chromosome 5q13 in two highly homologous copies (telomeric and centromeric) within the spinal muscular atrophy region. In this study, the neuronal apoptosis inhibitory protein gene deletion was analyzed in 34 spinal muscular atrophy families, with the consanguinity rate of 65% (22/34), in whom exon 7 of the survival motor neuron-1 gene was already confirmed and was deleted in 79% of the affected individuals. Deletion analysis of exons 5, 6, and 13 of the neuronal apoptosis inhibitory protein-t gene was carried out in our samples. We found 80% neuronal apoptosis inhibitory protein gene deletion in 5q-spinal muscular atrophy patients (91% spinal muscular atrophy-I, 50% spinal muscular atrophy-II and -III), and in 5% (two of fourty) of spinal muscular atrophy parents. All the neuronal apoptosis inhibitory protein-deleted samples also lacked the survival motor neuron-1 gene. The neuronal apoptosis inhibitory protein gene deletion in spinal muscular atrophy-I was higher than the other spinal muscular atrophy types. The high frequency of neuronal apoptosis inhibitory protein deletion most likely reflects a higher frequency of survival motor neuron-1 deletions compared with survival motor neuron-1 to survival motor neuron-2 gene conversion in this population.

Congenital glucose-galactose malabsorption is a rare autosomal recessive disorder of the intestinal transport of glucose and galactose, leading to watery diarrhea, dehydration, failure to thrive, and early death. In this study, we analyzed D28G mutation in 16 family members of a patient with typical presentation of congenital glucose-galactose malabsorption with polymerase chain reaction-Restriction Fragment Length Polymorphism method. Nine members of this family were heterozygous for D28G mutation. To the best of our knowledge this is the first report of D28G mutation in Iran. Moreover, this simple typical PCR-Restriction Fragment Length Polymorphism method, allows immediate identification of D28G mutation.

Intravenous drug abuse is an increasing social and health problem. Repeated injuries to the veins, injection of some types of insoluble substances, and needle sharing habits result in various complications. Increasing incidence of major vascular complications has been reported worldwide. The objective of this study was to determine the epidemiology of vascular lesions in drug abusers. Medical records of 50 patients who were consecutively admitted to the surgical wards, presenting with a pulsatile mass, infection of the injection site, or venous thrombosis in the groin or cubital fossa were retrospectively reviewed.Of 50 patients studied, 88% were males and 12% were females. Most of the drug abusers were young. Eighty percent of the patients had an infected injection site in the groin, 12% in the cubital fossa, and 8% in other sites. Seventy-six percent of the patients had been injecting drugs for 10 years and the remaining 24% for more than 10 years. Pseudo-aneurysm was the final diagnosis in 27 (54%) patients. In females, the vascular lesions diagnosed were pseudo-aneurysm in four, deep venous thrombosis in one, and arterio-venous fistula in another patient. Among male patients, pseudo-aneurysm was present in 23 (52%), venous thrombosis in eight (18%), necrotizing fascitis in three (7%), vascular abscess in two, and arterio-venous fistula in one (5%). Most of the vascular lesions involved the groin or cubital fossa and presented as a pulsatile mass. They may benefit from early referral to a vascular surgery unit. Infected pseudo-aneurysm is the most common pathology in our population and the best management for all infected pseudo-aneurysms is the ligation of the artery.

Earthquake is a natural disaster, which causes many psychological problems in survivors. Complicated grief is one of these sequelae. A devastating earthquake with a magnitude of 6.3 on the Richter scale destroyed the city of Bam in Kerman Province, Iran. Twenty-six thousand people were killed. Many of the survivors should have developed psychological problems in the aftermath of the disaster. In this study, we examined the prevalence of complicated grief and its correlation with the demographic factors and some suggested contributing variables. In this cross-sectional study, 400 persons were selected by stratified multistage area sampling. The survivors were interviewed in their temporary residential camp. After evaluating their demographic data, they were evaluated with the inventory of complicated grief. The cut-off point was set to 25. The mean±SD age of the participants was 37.8±12.7 years. Complicated grief was detected in 304 (76%) of the respondents. Score of complicated grief was higher among women and in those with lower educational levels. Presence in the city during the earthquake, observing burial of corpses, destruction of residential homes during the earthquake, residential problem after the catastrophe, and loss of at least one of the first relatives during previous earthquakes were variables which were correlated with the complicated grief. Existence of complicated grief in more than two-thirds of respondents requires more attention of mental health services. Rebuilding of homes and solving the residential problems of survivors are the factors, which could help survivors to find their mental health within a shorter period

Diabetic ketoacidosis is a major source of morbidity and mortality in children and adolescents with type I diabetes mellitus. Although, diabetic ketoacidosis is often associated with dehydration and electrolyte disturbances, cases with gastrointestinal tract complications due to shock remain particularly unusual. Herein, we reported on a five-year-old girl who had severe diabetic ketoacidosis complicated by hypovolemic shock. Her abdominal pain and acidosis despite vigorous fluid resuscitation and insulin therapy failed to improve. Further investigations showed intestinal problem. At laparatomy gangrenous bowel—about 20 cm long—near the distal ileum was found. Entrectomy and ileo-jejunal anastomosis was done and the child survived

Lipedematous alopecia and lipedematous scalp are two similar unusual conditions mostly affecting healthy black women. Here, we report one such case with emphasis on clinical and histologic findings, and review the literature on the subject. The presence of ecstatic lymphatic vessels with hair loss was particularly emphasized. Our findings suggest a lessened role of racial factors but confirm the sex implications and significance of lymphangiectatic vessels in development of alopecia in this condition.

Dental professionals play an important role in discovering the early signs of many illnesses. Gardner’s syndrome, which affects one in 7500 births in the United States, is an inherited autosomal dominant disorder. There are three distinctive features associated with this syndrome: familial intestinal polyposis or adenomatosis, surface tumors of hard tissues particularly osteoma in the skull, maxillae, and mandible, and finally surface tumors of the soft tissue. The intestinal polyps have a 100% risk of undergoing malignant transformation if not treated. Consequently, early identification of the disease is critical. In this article an 18-year-old male patient with previously undiagnosed Gardner’s syndrome who presented for removal of multiple impacted and unerupted teeth is reported to illustrate the importance of early detection and proper referral. This report describes an unusual presentation of a patient seeking extraction of teeth only, while he was totally unaware of potentially deadly situation.