Archives of Iranian Medicine
Volume:12 Issue: 2, mar 2009

Heart transplantation in Iran was first performed in July 1993. Since then, Shariati Hospital, affiliated to Tehran University of Medical Sciences, has been representing the most active center of cardiac transplantation in Iran and one of the major sites in the Middle East. This is a comprehensive review of our 15-year practice registry to make a scheme of our record and achievements. Clinical data on all consecutive transplanted patients from the Department of Cardiac Surgery, Shariati Hospital, Tehran, Iran over the last 15 years were reviewed. Descriptive and analytical statistics were extracted in regard to recipients, donors, surgical characteristics, and current status of the patients on follow-up. Totally, 90 patients were transplanted since 1993; 11, 32, and 47 in three five-year periods, respectively. The mean age of the recipients was 29.30±13.17 years. Motor-vehicle accident was the main cause of brain death of donors (48.8%). The most common indication for surgery was idiopathic dilated cardiomyopathy (75.5%).The mean survival rate has been 6.66±0.87 years. One-year and five-year survivals had a rising trend through the five-year periods. Acute allograft rejection and infection were the two major events complicating our transplants. This study shows that despite a vast variety of obstacles, we have passed the primitive milestones. The number of transplants is increasing at a higher rate in recent years, and patients’ survival rates and outcomes seem to be improving.

Arterial hypertension is an important risk factor for coronary artery disease and cardiovascular-induced morbidity and mortality. It can cause end-organ damages such as cerebrovascular diseases, renal failure, and congestive heart failure. On the other hand, because of elevated blood pressure and rapid blood flow, there is an increase in oxidation and peroxidation reactions. The aim of this study was to evaluate the level of oxidized low-density lipoprotein and superoxide dismutase activity in sera of hypertensive patients. In this case-control study, 70 hypertensive patients without any other important diseases such as congestive heart failure, cardiomyopathy, liver disease, diabetes mellitus, renal disease, or thyroid disease were compared with 70 age-and gender-matched controls. The participants'' age range was from 30 to 75 years. Measurement of oxidized low-density lipoprotein in serum was performed by enzyme-linked immunosorbent assay. The activity of superoxide dismutase in serum was measured by enzymatic colorimetry method. The patients'' mean age±SD was 52.2±14 years. The controls'' mean age±SD was 45±13 years. The level of superoxide dismutase activity in the patients'' group was 100±27 U/mL, and in the controls’ group was 105±11 U/mL. The level of oxidized low-density lipoprotein in the patients'' group was 14±4 mu/L, and in controls it was 7.7±3 mu/L. Data of this study demonstrated an elevation of oxidized low -density lipoprotein in hypertensive group that may be the result of oxidation processes. Superoxide dismutase activity was decreased in hypertensive patients, which can be the result of elevated oxidation reactions.

Oxidative stress is involved in the pathophysiology of diabetes mellitus. In the present study, 68 patients with type 2 diabetes mellitus and 31 clinically healthy individuals were evaluated. The patients were divided into two groups. Group 1 included 29 patients without diabetic complications and group 2 consisted of 39 patients with diabetic complications. Erythrocyte glutathione, superoxide dismutase, and thiobarbituric acid-reactive substance levels as well as plasma antioxidant vitamins C and E, and serum total glutathione-S-transferase, ceruloplasmin, and protein thiols were estimated by using spectro-photometer. A significant decrease of erythrocyte glutathione was observed in group 1 when compared with the controls. Thiols decreased in group 2. An increase in glutathione-S-transferase, ceruloplasmin, superoxide dismutase, and vitamins C and E levels was noted in patients with diabetes mellitus. Thiobarbituric acid-reactive substance levels decreased in group 1 but increased in group 2 when compared with the controls. In the present study, tendency of most of the antioxidants to rise in diabetes could probably be due to an adaptive response to the pro-oxidant milieu of the diabetic state. Hence, we suggest that supplementation with dietary antioxidants especially antioxidant vitamins accompanied by change in lifestyle might help to reduce damage brought about by free radical toxicity in diabetes mellitus.

There are no data on the prevalence of occupational noise-induced hearing loss in drivers using standard audiometric testing. The aim of this study was to estimate the prevalence and risk factors of occupational noise-induced hearing loss in drivers. A cross-sectional study was conducted on a random sample of 4300 long-distance drivers age ≥20 years taken out of a total of 10,000 estimated professionals in the city of Isfahan, Iran, from February 2006 through March 2007. The drivers were interviewed and underwent clinical and laboratory examinations including measurement of blood pressure, anthropometric data, and pure-tone audiometry in a sound-treated booths. The mean (SD) age of the participants was 40.8 (11.0) years with a mean (SD) duration of professional driving of 14.7 (9.6) years. The prevalence of bilateral noise-induced hearing loss was 18.1% [95% confidence interval (CI) 17.0~19.3]. The prevalence rates were higher in the left ear only 6.5% (95% CI: 5.8~7.3) than the right ear only 3.0% (95% CI: 2.5~3.9). Using a stepwise binary logistic regression model for the right and left ear only and for both ears separately, age was a significant independent predictor of bilateral noise-induced hearing loss and for the left or right ear only. When bilateral noise-induced hearing loss was entered in the model, fasting blood glucose was a significant predictor of noise-induced hearing loss. Blood pressure, cholesterol, triglyceride, body mass index, and marital status had no significant independent association with noise-induced hearing loss when other covariates were considered. These findings indicate that noise-induced hearing loss among the long-distance drivers appears to be similar to the world''s population endures noise-induced hearing loss caused by occupational exposure to noise, with higher prevalence in the left ear only.

Although it is well-known that the incidence of developmental delay in high-risk infants is higher than in low-risk ones, little is known about the risk factors among Iranian infants. The objective of this study was to determine the various pre-, peri-, and neonatal factors in developmental delay in participants and to compare the incidence of each factor with that of the normal population. The Infant Neurological International Battery developmental assessment was employed as the diagnostic tool by a team of experts. Neurological examinations were performed and a questionnaire was completed as well. The subjects consisted of 6,150 infants divided into two groups respectively, with normal and abnormal scores for the evaluation over a period of 12 months in city of Karaj (Tehran Province). The mean age of the participants was 39 weeks. Factors associated with a significant increased risk of developmental delay in the studied population included postneonatal seizures (OR=5.54, 95%CI: 3.1 – 9.6), neonatal seizures (OR=4.37, 95%CI: 1.7 – 10.8), preterm delivery (OR=2.52, 95%CI: 1.3 – 4.7), and type II pneumonia (OR=2.39, 95%CI: 1.4 – 3.8). To increase the survival rate of neonates and effectiveness of early interven­tion, the above-mentioned risk factors could be considered as valuable clues. Routine neurodevelopmental screening for neonates and infants for early detection of neurodevelopmental delays is highly recommended. If economic limitations prevent mass-screening of neonates, at least high-risk infants should be routinely re-evaluated.

The present study aimed to determine the rate and cause of the mortality of the Iranian ex-prisoners of war in Iraqi detention camps during a ten- year period (1980 – 1990) according to the documented reports. The information extracted from the documented death certifications that have been provided by the Iraqi authorities and the Red Cross delegation. At least a total of 564 Iranian prisoners of war died due to the various reasons in Iraqi detention camps that show a mortality rate of 1.4% (564/40,000). The mean captivity-to-death interval was 440 (from one to 3582) days and the registered prisoners had more duration of captivity than the unregistered (1285 vs. 215 days, P= 0.001). The median and mean ages of the individuals at the time of death were 22 and 26.4+13 years, respectively. The mean age of the civilians was higher than the others (45.3 vs. 23.7, P=0.0001). The cause of death was not clear for 44.3% of the individuals but among the others, infectious diseases (such as dysentery, sepsis, and meningitis) and injuries (resulting from war injuries and/or torture by Iraqi forces) were the main causes of death with 15.4% and 15.6%, respectively. It seems that the mortality of the Iranian ex-prisoners of war in Iraq is more than previously reported. Therefore, more investigation is recommended to determine the exact number of the Iranian prisoners who died in Iraq.

Anemia is a frequent complication of infection with human immunodeficiency virus (HIV). The causes of HIV-related anemia are multifactorial. This study was conducted to evaluate the factors associated with anemia in HIV-infected patients. A total of 642 patients with HIV/AIDS attending the HIV Clinic at Imam Khomeini Hospital in Tehran, Iran enrolled in this study. A detailed history and physical examination was done for all the patients. Investigations included CD4+ count, hemoglobin concentration, and red blood cells morphology. Among HIV-infected patients, 87% were males. The mean duration of antiretroviral therapy was 17.9±9.2 months. The mean (±SD) hemoglobin level was 12.9 ±2.31 mg/dL. Evaluation of red blood cell morphology showed macrocytosis in 11%, normocytosis plus normochromia in 41.1%, and microcytosis plus hypochromia in 47.9% of the patients. The prevalence of anemia (defined as hemoglobin<10 mg/dL) was 10.3%. Anemia was positively associated with female sex (OR=3.01), CD4 level (CD4 count of <200) (OR=3.49), and antituberculous drug administration (OR=4.57). Female sex, stage of HIV infection, and antituberculous drug use were the most important factors associated with anemia in HIV-infected patients in our study.

Crimean-Congo hemorrhagic fever was rarely reported from Iran before 1999. In a recent outbreak, the disease has been reported from different provinces of Iran, especially from Sistan and Baluchestan. Ribavirin has been recommended by World Health Organization as a potential therapeutic modality for Crimean-Congo hemorrhagic fever. This study was conducted to determine the clinical outcome and the effect of ribavirin in two groups of patients with Crimean-Congo hemorrhagic fever who were treated at different times. In this cross-sectional study, we evaluated patients with Crimean-Congo hemorrhagic fever who were admitted to Boo-Ali Hospital in Zahedan, a subtropical area in southeastern Iran, at the first three years after beginning of the last outbreak (1999 – 2003) and those who were admitted during 2005 – 2007. First, we found all patients with confirmed Crimean-Congo hemorrhagic fever infection who were treated with oral ribavirin. Then, they were evaluated for recovery and mortality rate. We evaluated 123 patients with confirmed Crimean-Congo hemorrhagic fever infection (91 patients treated between 1999 and 2003, and 32 patients between 2005 and 2007). Among the 91 patients, 73 (80%) survived, and 18 (20%) died of the disease. During 2005 – 2007, among the 32 patients who were treated within three days of onset of the disease, only one (3%) died of the disease. The recovery rate was higher among patients who were admitted during 2005 – 2007 than those hospitalized between 1999 and 2003 (97% vs. 80%). There was a significant (P=0.001) difference in the mortality rate between the two groups. Prompt treatment with oral ribavirin can increase the recovery rate in patients with Crimean-Congo hemorrhagic fever.

The study aimed to (dis)prove the association of the level of women''s empowerment with their future intention to perpetuate female genital cutting for their daughters. In a national representative community-based sample of 14,393 currently-married women in Egypt, the level of empowerment, intention to continue the practice, and other socio- demographic variables were collected in the 2000 Egypt Demographic and Health Survey. Secondary in-depth analysis was conducted on data downloaded from MEASURE Demographic Health Surveys (MEASURE DHS) website. About 14% of the women intended to discontinue the practice. Twenty-six percent of the women were empowered in all household decisions. Levels of women''s empowerment adjusted for age, residence, education, interaction between empowerment and education, work status, and female genital cutting status of currently-married women were entered in six logistic regression models in a sequential way. In the last model, those of high levels of empowerment and education were 8.06 times more likely not intending to perpetuate female genital cutting for their daughters than low- empowered low-educated women.

Although the incidence of colorectal cancer in Iranian older age subjects is currently very low compared to Western population, the younger generation is experiencing an accelerated rate approaching the Western rates and the burden of disease will increase dramatically in near future. The high frequency of positive family history of colorectal cancer in Iranian patients indicates that a significant number of colorectal cancers in Iran arise in family members and relatives of colorectal cancer patients. It is clear that the familial clustering of colorectal cancer is more often seen in younger probands and cancer located in the right side of the colon. These epidemiologic findings call for a broader attempt to promote public awareness and screening strategies in those families with a member affected by colorectal cancer, especially at younger age or with proximal tumors. Based on our present understanding, the possibility of preventing or curing most colon and rectal cancers is now plausible. The molecular biology of colon cancer has been the subject of many researches and is better understood than those for any other solid cancer and have established an important example for cancer research. It is now clear that colorectal cancer develops as the result of genetic and epigenetic alterations that lead to malignant transformation of normal mucosa. In spite of these scientific progresses and the fact that screening can reduce the rate of death by detecting early cancer or premalignant polyps, the rate of screening is very low globally and negligible in Iran and many other developing countries which is due to cost, resistance by physicians, patients, and the healthcare system. In Iran screening should at least be started in family members at earlier age with colonoscopy as the preferred modality of screening method.

To promote organ transplantation in Iran, organ procurement from deceased donors should be supported. For this policy, some organ procurement units have been established in university hospitals. Further researches in these activities are warranted to better elucidate the role of cadaveric organ transplantation in Iran.We retrospectively studied deceased organ donation from June 2005 through December 2007 in Organ Procurement Unit of Shariati Hospital in Tehran. We analyzed a total of 141 organs that were retrieved from 46 brain-dead organ donors.The median age of all donors was 29 years (min: six, max: 63). Two third of them were males. The average of harvested organs was 3.06 per donor and four organs per month. The main cause of brain death was head trauma (n=33, 72%). Organ yield per donor was correlated to the time of the organ procurement unit activity and increased during the three years (r=0.261, P=0.017). Other variables were not changed during this period. Donor characteristics such as age, sex, blood group, and causes of brain death impacted on the organ yield. This study showed that organ procurement units can improve organ yield and both experience and donor characteristics influence on the number of harvested organs.

Medication errors are among the most common medical errors in the hospitals. Transcription error is a specific type of medication errors and is due to data entry error that is commonly made by the human operators. This study was designed to detect transcription errors in a teaching hospital in Tehran. Direct observational method was used in this study. Error was defined as any deviation in transcribing medication order from the previous step (order on the order sheet, administration nursing note and/or cardex, documentation of the order in the pharmacy database). A total of 287 charts with 558 opportunities for error were reviewed. Of those opportunities for error 167 (29.9%) resulted in an error. Omission (the patient did not receive the medication that was ordered) was the highest (52%) transcription error type seen in this study. The evaluation clearly showed that errors at transcription stage were not infrequent. To cut these errors down we suggest implementation of surveillance systems, which might help to decrease medication errors.

Familial lecithin-cholesterol acyltransferase deficiency is an uncommon autosomal recessive disorder from a heritable defect in esterification of plasma cholesterol. In 1968, the disease was described by Gjone and Norum in Norway. Our case was a 38-year-old woman. Her disease was manifested by presence of lower extremities edema, proteinuria, corneal opacities, increased plasma cholesterol, and hemolytic anemia. Suspicion of the disease was based on renal biopsy, which revealed mesangial expansion and capillary wall widening with clusters of foamy cells in the mesangium. Immunofluorescence study was nonspecific, but specific findings of electron microscopy showed deposition of lipid in the glomerular basement membrane and mesangium. This is the first report of lecithin-cholesterol acyltransferase deficiency in Iran.The diagnosis was confirmed by a low high-density lipoprotein cholesterol concentration, decreased activity of lecithin-cholesterol acyltransferase in plasma, and positive familial history of the disease.

Lymphangioleiomyomatosis, a multisystem disease characterized by cystic lung lesions can result in respiratory failure and is considered to be sex hormones related. No effective treatment for lymphangioleiomyomatosis is currently available. We report a 35-year-old patient in her second pregnancy. She also had experienced five episodes of spontaneous pneumothorax at the age of 30. Despite excessive estrogen production during pregnancy she had mild non-progressive exertional dyspnea without limitation of daily activities during pregnancy without deterioration of respiratory status.

Malignant transformation in a mature cystic teratoma of the ovary is rare. The most common malignancy is squamous cell carcinoma, which consists of about 75% of malignant transformations. In the present report, we describe a case of advanced-stage squamous cell carcinoma arising in a mature cystic teratoma. A postmenopausal 63-year-old woman with squamous cell carcinoma arising in a mature cystic teratoma is presented. The initial investigation by ultrasound showed a left adnexal mass with mixed echo pattern, which arose the suspension of malignancy. She underwent a laparotomy and left oophorectomy. Histopatholog was compatible with squamous cell carcinoma arising in a mature cystic teratoma. After a few episodes of intestinal obstruction and colostomy, she underwent partial resection of the ileum and sigmoid colon four months after the initial oophorectomy. Histopathologic study showed metastatic poorly-differentiated squamous cell carcinoma. Subsequently, she underwent two courses of combination chemotherapy with cisplatin, leucovorin, and 5-fluorouracil with no response. She died from progression of the disease nine months after the initial operation.

We report a patient who presented with two episodes of severe hypertension after intramuscular injection of betamethasone. The first attack was associated with pulmonary edema, while the second attack was associated with high anion gap metabolic acidosis, renal failure, hyperglycemia, and hypokalemia. The attacks led to the diagnosis of pheochromocytoma, which was confirmed by appropriate diagnostic tests. The tumor was excised successfully and the patient is presently asymptomatic.We believe that these episodes were initiated by glucocorticoid injection, an event reported in a few cases. We briefly review potential mechanisms resulted in hypertensive crisis in such patients.

The history of the publication of biomedical journals parallels the development of modern medicine in Iran. Modern medicine was introduced to Iran in the mid-nineteenth century, particularly after the establishment of the Dar al-Fonun School in 1851. The foundation of this collage of higher education was instrumental in further advancement of modern medicine together with the publication of medical textbooks, but the biomedical journals were published later i.e. at the beginning of twentieth century and the first weekly public health periodical was established in 1901. From that point onwards, especially following the inauguration of the Faculty of Medicine of Tehran in 1934, the number and diversity of biomedical journals was gradually increased and their scientific quality was also improved.The present paper explores briefly the history of publication of 105 medical, dental, pharmaceutical, and public health journals from the early twentieth century up to the Islamic Revolution of 1979.